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Full text of "Notes on the history of military medicine"

West Virginia University Libraries 



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02237026 8 



F. H. GARRISON 



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NOTES ON THE HISTOR\ 
OF MILITARY MEDICINji 



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F. H. GARRISON 
NOTES ON THE HISTORY OF MILITARY MEDICINE 



Digitized by the Internet Archive 

in 2011 with funding from 

LYRASIS Members and Sloan Foundation 



http://www.archive.org/details/notesonhistoryofOOgarr 



Fielding H. Garrison 

Notes on the History 
of Military Medicine 



Mit einem Vorwort von 

Horst Zoske 



1970 

GEORG OLMS VERLAG 
HILDESHEIM ■ NEW YORK 






Erschienen 1922 als Sonderdruck aus Military Surgeon, 1921-22. 
Die Voriage befindet sich im Privatbesit2. 



Reprografischer Nachdruck der Ausgabe Washington 1922 

Printed in Germany 

Herstellung: fotokop wilhelm weihert, Darmstadt 

Best.-Nr. 5102 809 



VORWORT 



Als Garrisons Buch 1922 auf dem Biichermarkt erschien, waren die Zeitverhalt- 
nisse der Verbreitung des Buches in Deutschland wenig giinstig. Es fand nur in 
einem Exemplar den Weg in die offentlichen Bibliotheken. Auch die Jahrgange der 
Zeitschrift The Military Surgeon, die Garrisons Vorlesung fiir amerikanische 
Sanitatsoffiziersanwarter zuvor gebracht hatte, waren nur liickenhaft vorhanden. 
Der Verleger hatte es deshalb schwer, an einen reproduktionsfahigen Text fiir den 
Nachdruck zu kommen. Durch diese Verzogerung erscheint der Band nun aber 
gerade zu Garrisons Centenarium. 

Die Verwundetenfiirsorge, die Organisation des Sanitatsdienstes und die mili- 
tarische Gesundheitspflege sind ausfiihrlich dargestellt, daneben kommen auch 
Detailschilderungen nicht zu kurz. Karl Sudhoff riihmte das Buch als „bewun- 
dernswerten Uberblick iiber die Gesamtentwicklung des Militarsanitatswesens." 
Nach Hermann Frolichs Militiirmedicin (1887) und den Arbeiten von Emil 
Knorr (1880), Paul Myrdacz (1895—98) und 5. Kirchenberger (1895—96) iiber 
das Sanitatswesen der verschiedenen europaischen Staaten und ihre Kriege im 
19. Jahrhundert war keine grofiere Geschichte der Militarmedizin mehr erschienen. 
Garrisons Werk schlieSt eine Liicke in der Literatur, denn die (damals) neueren 
Veroffentlichungen sind darin verarbeitet. Seitdem wagte sich kein Medizin- 
historiker wieder an eine vergleichbare Synopsis, die den zeitlichen Anschlu6 an 
Garrison herstellen konnte. Diesem mangelte es allerdings auch nicht an den Vor- 
aussetzungen, die ihn zu einer solch zusammenfassenden Leistung befahigten. In 
ihm sind Arzt, Bibliothekar, Bibliograph und Historiker eine sonst selten zu 
beobachtende gliickliche Synthese eingegangen. Als er seine Notes veroffentlichte, 
tat er allerdings gerade als reaktivierter Oberstleutnant des Sanitatskorps Dienst 
in verschiedenen Camps der U.S. Army in Amerika, „statt — wie sich Sudhoff 
entriistete — auf dem hervorragendsten Lehrstuhl der Geschichte der Medizin, der 
in den Vereinigten Staaten erst noch zu schaffen ist, an der namhaftesten Uni- 
versitat dieses Landes Studenten der Medizin mit historischem Geiste zu erfiillen." 
Der bis jetzt noch grofite Medizinhistoriker amerikanischer Abkunft verbrachte 
1922 bis 1924 auf den Philippinen im militararztlichen Verwaltungsdienst, danach 
arbeitete er in der medizinischen Abteilung des War Department, bis er 1930 mit 
dem Grade eines Obersten verabschiedet wurde. 



VI* 

Garrison hatte sein Studium alter und moderner Sprachen wie der Mathematik 
1890 mit dem Bakkalaureat und das der Medizin 1893 mit der Promotion abge- 
schlossen und war bereits 1889 oder 1891 als Assistant Librarian in die Spitzen- 
behorde des militarischen Sanitatswesens der Vereinigten Staaten eingetreten. 
Deren Bibliothek war damals schon die gr6l3te Spezialbibliothek der Welt. Diese 
Stellung hat sie bis zum heutigen Tag halten und durch die Einfiihrung der mo- 
dernen Methoden der Datenverarbeitung sogar noch festigen konnen. Den Grund- 
stock zu ihrer Entwicklung legten zwei Arzte, John Shaw Billings (1838—1912) 
und Robert Fletcher (1823—1913). Als Garrison zu ihnen stiefi, hatten sie den 
Index medicus (1879) und „Amerikas groiite Gabe an die Medizin", den Index- 
Catalogue of the Library of the Surgeon-General's Office, United States Army, 
Washington (1880) bereits in Gang gesetzt. Sich gegenseitig erganzend bringen 
diese beiden monumentalen Werke und ihre Nachfolgeveroffentlichungen unter 
verandertem Titel bibliographisch erschopfend die medizinische Literatur. Garri- 
son war an ihnen als Mit- und Alleinherausgeber Jahrzehnte hindurch beteiligt. 
IJber das Gesamtwerk Garrisons gibt sein Biograph Solomon R. Kagan fiinf 
Jahre nach seinem Ableben Auskunft (1938). Sein wichtigstes Opus, An Intro- 
duction to the history of medicine (1913), wurde ins Spanische iibersetzt und er- 
fuhr mehrere, darunter auch verbesserte Auflagen (^1929). Es war seinerzeit die 
genaueste und vollstandigste Darstellung der Fortschritte der Medizin des 19. und 
20. Jahrhunderts. 

HORST ZOSKE 



Notes on the History 
Of Military Medicine 



(Expanded from two leclwes delivered al The Medical Field Service School, Carlisle Barracks. Pa. 

June 21-22, 1921) 



BY 

Lieut. Col. Fielding H. Garrison 

Medical CorpSy United States Army 



{Reprinted from the Military Surgeon, 19''21-22) 



WASHINGTON 

ASSOCIATION OF MILITARY SURGEONS 

1922 



CONTENTS 

Page 

Chapter I. Introductory 1 

n. Antiquity, including Greece 22 

in. Rome 47 

IV. The Middle Ages 77 

V. The Sixteenth Century 98 

VI. The Seventeenth Century 118 

VII. The Eighteenth Century 135 

VIII. The Nineteenth Century 160 

IX. The Twentieth Century, including the World War 188 



PREFACE 

In their present form these chapters, originally printed in The 
Military Surgeon during November, 1921 — August, 1922, are an 
expansion of two lectures delivered at the Medical Field Service School, 
Carlisle Barracks, Penna., on June 21-22, 1921. Designed as they are 
for the information and instruction of student medical officers at the 
Army Medical School, they cannot profess to give more than a definitive 
outline of the history of a great subject. But with the aid of the foot- 
note references, derived from the matchless resources of the Surgeon 
General's Library, it is conceivable that the senior officer may be in 
position to expand the theme indefinitely for purposes of lecturing, 
writing or otherwise. 

During the World War the United States Army, particularly its 
Medical Corps, had an opportunity to achieve great results on a grand 
scale such as had never been offered it before in all its history. One 
effect of this great expansion, this unique opportunity to think in large 
terms, was to dispense, for the time being at least, with certain obsolete 
or obsolescent conventions of the service which had tended to narrow 
the viewpoint of the individual and, in extreme cases, demonstrably 
to engender bitter hatred against the Army in certain quarters. 

In other words, military discipline is now an affair of handling the 
individual with such impersonal equity and fairness as to make him a 
true disciple (discipulus) of the centric ideal, viz., the preservation of 
our Army for the maintenance of peace and for the defense of oar 
common country in time of war. During the recent war the science of 
military morale was so effectively developed by one of our medical 
officers that it became possible to manufacture reliable conduct in men 
"like cotton cloth." The merest glance at these pages will convince 
any candid reader that the part played by medical personnel in the 
maintenance of military morale is of extraordinary moment. It was 
to forward this motif that this book was written, in the hope and belief 
that a glimpse of the "ampler aether" which is the history of his pro- 
fession will convince the young medical officer that, in successful military 
operaticins of modern type, patriotism is the motor power, and military 
administration the mechanism by means of which great things are to 
be accomplished and victories won. 

In completing these pages the writer desires to express his sincere 
gratitude to Col. James Robb Church, editor of The Milit.^ry Surgeon, 
for advice and encouragement, and to Major Arthur N. Tasker, M.C., 
and Mr. S. E. Womeldorph for timely assistance in the revision of copy 
and the correction of proofs. 

F. H. G. 
Washington, D. C, 
September 5, 1922. 



CHAPTER I 

Introductory 

SINCE the time of Frolich^ it is commonly agreed to include under 
the term "military medicine" all that relates to military hygiene and 
sanitation, military surgery, medico-military administration, medico- 
military transport, recruiting, sanitary formations and training. 

The history of military medicine has two main aspects, the pro- 
fessional or scientific and the administrative. Progress in military 
medicine, as a branch of medical science, has turned upon two principal 
coefficients — the advancement of scientific surgery and the advancement 
of the science of infectious diseases. Bacteriology has done more for 
this phase of the subject than anything else. The development of 
medico-military administration as a mechanism to assist in winning 
victories and to further the ends of medical science has turned upon 
a single factor, viz., the need of any nation for an organized standing 
army, however small as a mechanism for its defense in time of need. 
In past history, the fate of all armies hastily levied, without forethought 
and preparedness, has been monotonously the same — faulty sanitation, 
tremendous mortality from communicable diseases, disastrous mortality 
from battle wounds. Except in well-organized armies, like the Roman 
or those of Frederick and Napoleon, never a sign of a sanitary formation, 
significant silence in the records as to organized care of the sick and 
wounded. In modern times the need for some sort of military organi- 
zation as a nucleus for the defense of a nation in time of war has been 
recognized by every modern state. Armies exist so long as war remains 
a biological phenomenon beyond the control of man, and even should 
the possibility of war be reduced to a minimum (on paper), small armies 
and navies will still be necessary to maintain the peace of the world. 

Wars are only a phase of the general phenomenon that life itself, 
in all its aspects, is conditioned by a conflict of elements, the nature of 
which we but dimly comprehend, beyond the well-known law of physics 
that forces always flow from higher to lower potentials. Wherever life 



' H. FrSlich: Militararzt, Wien, 1874, xiiv, 45; 57, and the introduction to hia Milit&rmedicin, 
Braunschweig, 1887, 1-4. 

1 



2 History of Military Medicine 

manifests itself upon earth, there is a constant warring of diverse ele- 
ments, without which there is apt to be decadence and stagnation. 
The painful evolution of man himself from his low prehistoric estate as 
an animal to his present civilized status was accomplished in just 
this wise. Not a single advance in our boasted civilization was made 
without conflict over contested ground. Physical chemistry teaches 
that life turns upon the surface energies of protoplasm. One of the 
greatest of modern physicists asserts that the struggle for existence of 
living matter is a war for free energy, and that when the free energy of a 
living organism (say a defenseless nation) becomes a minimum, its death 
is at hand. 

In prehistoric or primitive society man is a wild animal with 
many degrees of freedom, compelled to do his own thinking and quick 
to defend himself. In civilization he becomes a tamed or domesticated 
animal, like a fireside cat or a potted plant, with little freedom, hardly 
any mechanisms of defense, his thinking usually done for him by others. 
Human history in the past has been largely made up of raids and wars 
of lawless, nomadic, barbaric elements upon settled, civilized, domesti- 
cated elements, and where the latter has been overcome it is because 
they have lost the power and means of defending themselves. Thus 
the pacifists and idealists of defenseless nations are, in a sense, particeps 
criminis, passive and pacific agents of their own dishonor, of the possible 
enslavement and degradation of their women and children or of other 
people's women and children. The French proverb runs: Qui se fait 
brebis, le loup le mange. 

Beyond this statement of scientific fact, no explanation seems neces- 
sary for the existence of armies as such. The smallest nations, definitely 
organized as racial or social units, have never been without them in 
historic time, and for excellent reasons: if defenseless, they were sure to 
be invaded, subjugated, absorbed or partitioned through the intrigues 
of diplomacy and the " crimes of kings." The military status of Switzer- 
land was adequate to maintain the autonomy of this small but sturdy 
state during the entire European War, while the valiant stand taken 
by Belgium recalls the ancient tribute of Julius Caesar : fortissimi omnium 
horum Belgae. But the European war has brought in its train a vast 
diminution of the productive power of civilized humanity, a demoraliza- 
tion and degradation of human dignity, which has embittered thousands 
of minds and hearts and, as usual in history, this bitterness is vented 
not upon those who intrigued to make the war possible but upon the 
general theory of military establishments. It is characteristic of human 
nature and of the feebleness of the human mind that, in real life, the 



Antiquity, Including Greece 3 

true villains in the play should always manage to rehabilitate themselves 
in the last act and so get the better of the poor mens sibi conscia recti. 

The present feeling of the discharged civilian volunteer is expressed 
in the sentence of a living English novelist: "Everybody liked the war 
except those who had to fight it."^ The gigantic profiteering, the 
widespread decadence of morals, the enormous waste, as well as de- 
struction of human life and material resources, the impoverishment of 
hundreds who cheerfully gave up their all to find their occupations gone 
upon discharge from service, have produced in the civilian population 
a fierce and very natural reaction against warfare in general and expen- 
sive armaments in particular. 

While no individual battle of the World War was as destructive 
relatively as Thermopylae, or Cannae, or Gettysburg, or Custer's fight 
at Big Horn, the havoc wrought by high-power explosives and the 
employment of such offensive measures as gas attacks, air or submarine 
raids, which gave the victims no fighting chance, no power of motor 
resistance — all this has created a powerful world sentiment against the 
future possibility of wholesale slaughter of the defenseless, although the 
triviality of recent city life seems to "mock the riddled corpses round 
Bapaume." Military men, as well as statesmen, are therefore com- 
mitted to the hope and belief that world sentiment and the future 
solidarity of mankind may perhaps avail to diminish (if not entirely 
prevent) the megalomania of warfare for conquest by great powers; 
but, judging the future by the past, it is highly probable that small 
armies will always be necessary to execute the will of governments in 
maintaining world peace and as expansile nuclei for defense against 
invasion in time of need. Thus the organization, strength and efficiency 
of the German Army were admired everywhere, as long as that army 
was regarded as a bulwark of intranational stability, but the entire 
non-Germanic world turned against it when the great war itself was 
perceived to be a definite break-up of world-equilibrium, a special case of 
"inter-molecular wobble," which is said to have ruined the business even 
of caravans in the Far East. 

The soldier, in relation to world warfare and the possibility of the 
invasion and conquest of his country, is thus, in a sense, an analogue of 
the doctor, in relation to major epidemics and the protection of his 
clientele from communicable or fatal diseases. In time of peace the 
military man labors at humdrum duties, on relatively small pay, to 
assist his government in maintaining a stable social order; in time of 
war he is his government's principal agent and mainstay in elaborating 



• W. L. George: "Blind AUey." 



4 History of Military Medicine 

proper mechanisms of defense against the enemy. In time of peace 
the medical officer is the family physician and sanitarian of his particular 
organization; in time of war he must devise ways and means to forestall 
and prevent epidemic diseases and to deal with the "traumatic epidemic " 
which Pirogoff declared war to be. The analogy drawn by Crookshank* 
between the World War and the far most destructive epidemic of Spanish 
nfluenza (1918-19) seems true in all its parts. Both were biologicali 
phenomena, of remote, multiplex or undecipherable causation, arising 
suddenly, and nowise preventable by merely deciding or wishing that 
such things should not be; both were ultimately suppressed and ended 
by boldly going forth to meet them, venienti occurrite morho, on the 
principle of Newton's third law of motion. Assuming, then, that world 
peace, a stable intranational equilibrium, is the "far off divine event to 
which the whole creation moves," the soldier and the doctor are really 
working toward the same end, the soldier to diminish the possibility of 
wars of magnitude by the maintenance of world peace, the physician to 
prevent the occurrence, recurrence and spread of communicable diseases 
by sanitation. On that great day, when wars and disease shall have 
become non-existent, both may, like Wotan, cheerfully will their own 
annihilation. To that millennium, Billings applied the ironical "Ka- 
nuri" proverb: "The day being finished, there is an end of medicine." 

II. Bibliographical Sources 

The existing literature of military medicine is of unusual extent, and 
at sundry intervals of time, medical officers of different nations have 
striven to take an account of stock by arranging this complex material 
in some orderly and logical sequence. This is the function of medical 
bibliography, by which is meant, not the minute description of books, 
like objects in natural history, for identification by the bibliophile, but 
the arrangement of book titles and indexed articles in such wise that 
the physician may gain from it a complete purview of the existing state 
of knowledge of the given subject at the time the bibliography was pre- 
pared. A thoroughgoing analytical bibliography of a medical subject 
is the key to its literary history up to the time of preparation or publica- 
tion. Much may be done by this method, as a scaffolding for investiga- 
tion or writing. Thus the bibliography of pediatrics by F. L. Meissner 
(1850) contains all the literature from 1472 to 1850, arranged by subject 
headings, and affords a complete picture of the historical develop- 
ment of the specialty to that date. The same thing applies to Lehr's 
remarkable calendar of psychiatry (1901), which gives the literature 



« F. G. Crooksbank: Military Surgeon. Wash., 1921, xlviii, 172-179. 



Antiquity, Including Greece 5 

and events from 1459 to 1799, arranged in chronological order. In 
the Index Catalogue of the Surgeon General's Library the historical 
literature of military medicine is arranged, by wars and campaigns, 
in alphabetical order. Now the basic literature of the history of military 
medicine is peculiar in that, prior to the end of the eighteenth century, 
its meager data are commonly buried in secular (non-medical) writings 
and the memoirs of great personages, for in this earlier period medical 
oflBcers, as such, were non-existent, and military surgeons, when at- 
tached to armies, were virtually vassals and body physicians of kings 
and powerful nobles. After the eighteenth century, when the proper 
care of the sick and wounded soldier became a fimction of government, 
the basic (authentic) data are usually to be found in the military 
orders, circulars, statistical reports and other public or confidential 
documents of the military establishments of various nations. The 
approaches to the subject are therefore difficult, widely separated, and 
sometimes inaccessible. It is for this reason, as Straub once observed, 
that the history of military medicine, like the history of public hygiene, 
has remained largely unwritten.^ Excellent surveys are afforded in the 
histories of military surgery by Kohler (1901) and Cabanes (1918), 
but the subject has been otherwise investigated only in particular 
campaigns, histories of medical departments of armies and suchlike 
phases, and no consecutive and continuous history, based upon archi- 
vistic research, has been prepared to date. In the present brief narra- 
tive the writer can indulge no pretensions to the vast erudition and 
military experience required for the larger task, but on the assumption 
that a sketchy outline may at least stimulate others to further research, 
it is hoped that the bibliographical and similar data may be useful. 

The earliest list of bibliographical titles on military medicine is that 
of Carl Philipp Diez, consisting of valuable footnotes to his graduating 
dissertation on the condition of the atmosphere and of food as matters 
of moment in military hygiene (1762).* 

In the following year Ernst Gottfried Baldinger (1738-1804), a 
Prussian army surgeon and medical historian, published, as an appendix 
to his dissertation on diseases of armies (1763), an extensive biblio- 
graphj', which was separately printed as an enlarged second edition in 
1764.'' This important pamphlet, the starting point of all subsequent 

• Outside the military profession, the subject has otherwise excited no interest, for the reasons 
above given. One of the greatest of modern medical historians, when approached on the matter 
replied: "The subject is distasteful to me." 

' C. P. Diez: De aere et alimentia militum praecipuis hygienis militaris momentis, 4°. TUbingen, 
1762. 

' E. G. Baldinger: Introductio in notitiam scriptorum medicinae militaris. 8'. Berlin, 1764. For* 
detailed account of tlii.a work see H. Frolich: Deutsche Vrtljschr. f. olTentl. Gsndhtspflg., Braunschweig 
1875, vii. 362-366. 



6 History of Military Medicine 

bibliographies of military medicine, is arranged in seven sections, com- 
prising 133 titles, most of which are provided with brief critical or ex- 
planatory notes by the compiler. As more than half of this work (the 
surgical part) had been irrecoverably lost by the Berlin printers, Bald- 
inger frequently announced that he was working on a third edition, of 
which he published some fragments in 1791.* But this project he never 
lived to complete. After his death in 1804, his fine library of 15,559 
volumes was purchased by the Grand Duke of Hesse, to be absorbed 
by the Court Library at Darmstadt.^ 

Following the Baldinger publication, a number of other useful 
bibliographies appeared at intervals, viz. : 

1845. Irvixg (James): A Concise View of the Progress of Military Medical Litera- 
ture in this Country. James Irving (182£-98) was an Edinburgh medical 
graduate who entered the Indian Medical Service in 1847 and was the first 
surgeon general of the combined provinces of Bengal and Oressa (1878). 
His contribution of 82 pages gives concise analyses of all the important English 
books, from Gale's treatise on gunshot wounds (1563) to 1844, a period of 
nearly 300 years. His object, he admits, is to impress the young physician 
with the advantages of service in the British Army for "the study of practical 
medicine." 

1862. Rosier (Victor): Essai d'un bibliographic universelle de la m6decine et de la 
chirurgie militaire. Contains 4,424 titles, mostly French, and includes 
everything listed by Baldinger. 

1873. FRaLicH (Hermann): Zur Biicherkunde der militar-medicinischen Wissen- 
schaft. Contains an interesting list of titles, arranged in chronological order, 
from 1497 to 1872. While many important items are lacking, this list is a 
good conspectus of the progress of military medicine in time, as judged by 
the texts. The rest of Frolich's work, which is of a more important order, is 
given below. 

1876. Frankel (G. H. F.): Bibiiotheca medicinae militaris et navalis. Beitrage 
zur Literatur der Militar-und Schiffsheilkunde, Part I (Glogau, 1876). 
Consists of titles of graduating dissertations and academic programs, arranged 
in alphabetical order, with a subject index at the end. No more published. 

1880-1921. Index Catalogue of the Library of the Surgeon General's Office, 1-3 series, 
40 volumes. Edited by the late Col. John S. Billings and the successive 
librarians of the S. G. O. Contains subject bibliographies of all branches of 
military medicine. As these contain, for the first time, the articles indexed 
in medical periodicals, they are of more practical use than the earlier lists, 
made up of books and pamphlets alone. The more important rubrics are 
Armies; Army; Hygiene (Military); Medicine (Military); Surgery (Military), 
with subdivisions, e.g.. Medicine (Military, History of) by Campaigns, Sieges 
and Wars. These can easily be found, in proper alphabetical sequence, in each 
of the three series, which cover literature as follows: 1st Series (16 volumes, 
A to Z) from earliest periods to 1895; 2d series (21 volumes). 1896-1916; 3d 
series (3 volumes so far published), 1918 to date. 



• Baldinger: Neues Mag. f. Aerzte. Lnipxig, 1791, liii, 458-462. 

• Frtlich: MilitArmedicin, 1887, 6. 



Antiquity, Including Greece 7 

1914. Tight (Franz): Militarttrztliche Literatur in den Jahren 1700 bis 1850. 
Beitrag zur Geschichte der Medizin (Militararzt, Wien, 1908, XLII, 329. 
Deutsche mil.-arztl. Ztschr., Berl., 1914, xliii, 609-618). An analysis of 
the medico-military literature of 150 years (1700-1850). 

Perusal of any of the above are highly instructive, as indicating the 
kind of tasks and problems which occupied the minds of medical officers 
in the different historical periods. The reader may note, by simple 
inspection of the titles, the enormous literature of gunshot wounds and 
hospital gangrene, and the changes in point of view as to treatment; the 
speculations as to the nature of Hungarian camp (tj-phus) fever {De lue 
pannonica) during the sixteenth to eighteenth centuries; the extensive 
literature on Egyptian ophthalmia (trachoma) after the publication of 
Larrey's monograph (1802); on conservative amputation after Bilguer's 
essay (1761); on heat stroke, following the investigations of the Indian 
Medical Service; on malingering {De morbis fictis) and its detection from 
the earliest times; on moral support of the patient during amputation 
prior to the introduction of anesthesia; on the status of debridement 
from Larrey to Lemaitre; on the social distress and bad hygienic status 
of the population following the Napoleonic Wars {De damno et calamitaie 
quae in sanitatem publicam et societatem ex perpetuo bello redundat). 
Even a list of books shows that there is nothing new under the sun. 

Much more important for historical investigation is the work of a 
number of scholars who first grappled with special segments of this 
difficult material and endeavored to get the inwardness of it and to draw 
conclusions from it. Upon the findings of these investigators, much of 
recent writing has been based. Early in the nineteenth century (1807-9) 
nine dissertations were published by various medical students at the 
University of Wittenberg on the set theme: "In what manner did the 
Romans render aid to wounded soldiers in battle.^^" This was a new 
departure, something quite different from merely listing the books and 
analyzing them seriatim, as Baldinger had done for the literature up to 
1764, or Irving for the English literature between 1563 and 1844. As 
Latin students' dissertations go, this method was absolutely sterile 
and unproductive when applied to the live subject of military medicine 
itself, for the many Latin contributions of the seventeenth and eight- 
eenth centuries were written, not from actual fresh experience in the field, 
but merely as summaries of the works of predecessors, with a musty 
flavor of the lamp, the inkhorn and the stuffy little room with porcelain 
stove." But in establishing data for the history of our subject it was 



10 DUceptata quaestio: Quibus modis militibus in pugna vuloeratis succurerint Romani? Commen- 
tationes i-ix. 4°. Wittenberg, 1807-9. These are rare and not in the Surgeon General's Library. 

" For a sound view of this " Stubentvitstnschaft" see A. Dreyer: Med. Ztg. Russlands, St. Petersb 
1855. xil, 196-198. 



8 History of Military Medicine 

necessary that some such steps be taken. The most remarkable work 
in this Hne was done by Kiihn and FroHch. 

Kiikns Prolegomena 

The French surgeon, Verneuil, once observed that "while erudition 
certainly creates nothing, it leads to creation. To discountenance 
research in literature (he goes on to say) is like advising travelers who 
visit regions not fully explored to refrain from making use of the maps 
prepared by their predecessors. The great objection to such work is 
the amount of time which it requires, if it is to be done thoroughly and 
accurately." The life work of Carl Gottlob Kuhn (1754-1840) is 
exemplified in these lines. Professor of medicine at Leipzig for more 
than half a century (1785-1840), he was one of the greatest of medical 
scholars, an editor and commentator of all the older writings, from 
Hippocrates and Galen to Sydenham, Huxham and Baglivi. To him 
we owe the great bilingual of Galen in 20 volumes, which is still used in 
libraries along with Littre's bilingual of Hippocrates. During 1824-27, 
Kiihn published eight academic programs (faultily numbered, he admits, 
as I-VI, X, XI) on the status of military medicine among the Greeks 
and the Romans. ^^ These deal with (I) military medicine in the Trojan 
War (Homer), (H-III) in Xenophon, Polybius and Hyginus, (IV-V) 
in the Roman inscriptions of the Empire, (VI- VIII) in the legal codes of 
Augustus and the later emperors. Written in Latin, these studies are 
not readily accessible today, but Kiihn's findings have fortunately been 
absorbed in the general body of knowledge. This is evidenced by the 
amount of literature on Greek and Roman military medicine which has 
followed his original presentation of the theme, e.g., Zimmermann 
(1834), Sir James Y. Simpson (1856), Brian (1866), Gaupp (1869). 
More extensive independent and original investigation has since been 
made, notably in the solid monographs of Daremberg (1865), and Frolich 
(1879) on medicine in Homer; but much in the way of borrowed plumage 
and pasted jewels of citation is elsewhere easily traceable to the elder 
writer. 

FrolicJis Prolegomena 

A man of far different type was Franz Hermann Frolich (1839-1900), 
one of the surgeons general of the Saxon army (1893-1900). Frolich 
entered the military service before his graduation in medicine, served 
in three wars, and was a leading authority on his subject in his day. 
Beginning with his graduation dissertation (Leipzig, 1862),^^ his writings, 

" C. G. Kuhn: De medicinae militaris apud veteres Graecos Romanesque conditione. Program- 
mata I-VIII, 4°, Leipzig, 1824-7. 

u This, a study of temperature relations in typhoid fever in troops, was prepared under the direction 
of Wunderlich, and published three years before the appearance of the letter's treatise on clinical 
thermometry (1869). 



Antiquity, Including Greece 9 

219 in number, are exclusively about military medicine, and his grea 
treatise of 1887 was the first book in which the theme is treated by 
and large, in all its branches. His recommendations as to chest meas- 
urements in troops (1869) were officially adopted for the German army 
and navy ten years later (1879). He was a warm personal friend of 
Colonel Billings, librarian of the Surgeon General's Office, with whom 
his correspondence was extensive. 

Frolich, a man of fine classical education, was the most prolific of 
all -^Titers on the history of military medicine. His many contributions 
were undoubtedly so many preliminary studies to a complete book on the 
subject. The best of this material was, however, absorbed in his 
general treatise on "Militarmedicin" (1887), which begins with an 
extraordinary layout of the basic historical sources. The bibliographical 
sources for the military medicine of antiquity are accurately indicated, 
as to chapter and verse, from Homer and the Bible, through Livy, 
Caesar and the other Roman writers, up to the Dark Ages. The 
bibliography of the modern period is, however, poorly arranged and 
more difficult to follow. Frolich was, in fact, a careless bibliographer, 
but no one ever used this tool to better advantage. During his period 
of activity (1869-1901) he produced scores of books and articles dealing 
with every historical aspect of his subject, not all of equal merit, it is 
true, but unquestionably the best of their kind, and a source of inspira- 
tion to all future students. The literary style is somewhat diffuse but 
colorful, and the frequent handling of identical themes suggests that 
Frolich was working to perfect himself for a definitive summary of the 
whole subject. His amazing productivity is indicated in the following 
lists of titles :^^ 

18G9. J. A. a Gehema's book, "The well-equipped Field-Physician" (1684). Allg. 
mil.-arztl. Ztg., Wien, 1869, 195:204. 

1872. Celsus on the operative treatment of wounds from projectiles. Deutsche mil., 

arztl. Ztschr., Berl., 1871, I, 525-535. 

1873. On the bibliography of military medicine. 50 pp. 8°. Berlin, 1874. Supple- 

ment to: Deutsche mil.-arztl. Ztschr., Berl., 1873-4, II-III. 
Contributions to the history of military medicine. Allg. mil.-arztl. Ztg., Wien. 

1873, XIV, 4; 20; 28; 37; 41. 
Hieronymus Braunschweig on gunshot wounds (end of the fifteenth century). 

Militararzt, Wien, 1873, VII, 116-120. 
The outposts of medico-military literature, Militararzt, Wien, 1873. VII, 

17-20. 

1874. On the content of military medicine. Militararzt, Wien, 1874, XXIV, 45; 57. 



" This list has been prepared and verified from the somewhat faulty bibliography of his collective 
writings (1869-83), made by Frohch himself in Wien. med. Presse, 1884, xxiv, 999; 1061; 1039, and 
the completion of the same (1884-1901) in the obituary notice by Helbig in Reichs-Med.-Anzeiger, 
Leipz. 1900, xiv, 471-472. 



10 History of Military Medicine 

1874. On a discovery relating to the military surgery of the Middle Ages. Deutsche 

mil.-arztl. Ztschr.. Berl.. 1874, III, 583-594. 
On the history of military medicine in England. Militararzt, Wien, 1874, 

XXIV, 169; 179; 185; 195: 1875, XXV, 3; 11; 19; 51. 
History of the Regulations of the Medical Department of the German Army 

Vrtljschr. f. gerichtl. u. offentl. Med., Berl., 1874, XXI, 100-128. 

1875. On the earliest bibliography of military medicine. Deutsche Vrtljschr. f. 

offentl. Gsndhtspflg., Brnschwg., 1875, VII, 362-366. 
Guide to the investigation of the history of military medicine in antiquity. 
Militararzt, Wien, 1875, XXV, 177; 178. 

1876. The helmets of Homer's heroes. Arch. f. path. Anat.. Berl., 1876, LXVIII, 

381-398. 
The oldest known case of malingering. Feldarzt, Wien, 1876, XXI, 61; 65. 
Thoughts on the prehistoric origin and later developments of aid to the sick 

and wounded in war. Feldarzt, Wien, 1876, XXI, 81; 101. 

1877. Barracks in the Trojan War. Arch. f. path. Anat., Berl.. 1876, LXXI, 

509-514. 

Catalogue of the Library of the Medical Department of the Saxon Army. 
138 pp. 8°. Dresden, 1877. 

Medical features of the Turco-Serbian campaign of 1876. Deutsche mil.- 
arztl. Ztschr., Berlin, 1877, VI, 110; 168; 205. 

The Saxon Army Medical School. Feldarzt, Wien, 1877. 49; 53. 
1877-8. Periodical literature of 1870-76 on the medical history of the Franco- 
Prussian War. Feldarzt, Wien, 1877, 61; 65; 69; 78; 98; 1878, 2; 14. 
1877-82. Status of military medicine during the years 1877-82. Jahrb. f. prakt 
Med., Berlin, 1877-82, passim. 

1878. Ancient Oriental military medicine, Deutsches Arch. f. Gesch. d. Med., 

Leipz.. 1878. I. 27-42. 
The chiton of Homer's heroes from a sanitary viewpoint. Arch. f. path 

Anat. Berl.. 1878, LXXIII. 625-628. 
Contribution to the medical history of the Franco- Prussian War. Militararzt. 

Wien, 1878, XII, 185; 193; 204; 211; 217. 
Report on military medicine at the Paris Exposition of 1878. Deutsche med. 

Wochenschr., Berl. 1878, IV, 495; 507; 522. 

1879. Bibliography of recruiting. Schmidt's Jahrb., Leipz., 1879, CLXXXI, 

201-206. 
History of the Medical Regulations of the Saxon Army. Wissensch. Ber. 

d. k. sachs Sanitatsdienst, Dresd., 1879, 25-62. 
The military medicine of ancient Greece in the post-Homeric period. 

Deutsches Arch. f. Gesch. d. Med., Leipz., 1879, IL 395-404. 
Military medicine in Homer. 65 pp. 8°. Stuttgart, 1879. 
On the military surgery of the 17th Century. Deutches Arch. f. Gesch. d. 

Med., Leipz., 1879, II, 142-144. 

1880. The antiquity of gunshot wounds. Wien. med. Presse, 1880, XXI, 218-220. 
Historical data on the military medicine of the Germans in antiquity and the 

Middle Ages. Deutsches Arch. f. Gesch. d. Med., Leipz.. 1880, IH, 222- 

256. 
Paul of iEgina as a military surgeon. Wien. med. Wochenschr.. 1880. XXX. 

1241; 1265. 
On the basic periodical literature of military medicine. Schmidt's Jahrb., 

Leipz.. 1880. CLXXXVL 84-87. 



Antiquity, Including Greece U 

On the war surgery of the ancient Romans. Arch. f. klin. Chir., Berl., 1880, 
XXV, 285-321. 

1881. Historical aspects of recruiting from the viewpoint of military medicine. 

Mil. Wochenbl.. Berl.. 1881, No. 79. 

1882. On the beginnings of military medicine in The Middle Ages. Deutschea 

Arch. f. Gesch. d. Med.. Leipz.. 1882. V, 75-80. 
Some of the oldest essays on gunshot wounds. Arch. f. klin. Chir., Berl., 

1881-2. XXVII, 593-613. 
Notes on sanitation in the Egyptian campaign. Wien. med. Presse, 1882. 

XXIII, 1621; 1651. 
War-surgery a thousand years ago. Arch, f, klin. Chir.. Berl., 1882-3, 

XXVIII, 862-866. 

1883. The literary sources for the military medicine of antiquity and the Middle 

Ages. Wien. med. Presse. 1883, XXIV. 938; 1069. 

1884. Albucasis on war-surgery. Arch. f. klin. Chir., Berl., 1884, XXX, 364-376. 
Contribution to the literature of instruction in military medicine. Militttrarzt, 

Wien, 1884, XVIII, 107; 115. 
On the oldest Austrian periodical of military medicine. Militttrarzt. Wien. 

1884, XVIII, 102. 

On the ophthalmologist, G. J. Beer. Wien. med. Wochenschr., Berl., 1884, 

XXXIV. 1503-1505. 
The periodical literature of military medicine. Militttrarzt, Wien. 1884, 

XVIII, 67-70. 
War surgery in Avicenna. Arch. f. klin. Chir., Berl., 1884, XXX, 745-752. 

1885. The beginnings of military hygiene in the Middle Ages. Deutsche Vrtljschr. 

f. ofiFentl. Gsndhtspflg., Brnschwg., 1885, XVII. 433-436, Also: Militirarzt. 
Wien, 1887, XXI, 9-12. 
Cultural history of the aims of instruction in military medicine. Neue mil. Bl., 

1885, Hft. 1. 

Origin of military medicine. Militararzt, Wien, 1885, XIX, 81; 89. 

1886. War-wounds in the Middle Ages and their treatment. Oesterr. mil. Ztschr., 

Wien, 1886, 50. 

1887. The beginnings of military hygiene in antiquity and the Middle Ages. Mili- 

tararzt. Wien, 1887, XXI, 9-12. 
Bibliography and literary sources of the history of military medicine. In his: 
Militarmedicin, Braunschweig, 1887, 5-35. 

1888. History of the Medical Corps of the Saxon Army. 148 pp. 8°. Leipzig, 1888. 
Losses in war. Oesterr. mil. Ztschr., Wien, 1888, 90-109. 

The oldest medical regulations of the German Army. Mllnchen med. Woch- 
enschr., Munchen, 1888, XXXV, 910. 

1889. Officers' field-chests. Militararzt, Wien, 1889, XXIH, 113-117. 

Galen on malingering. Friedreich's Bl. f. gerichtl. Med., Niirnb., 1889, XL, 
21-26. 

1890. The earliest cases of gunshot wounds. Prag. med. Wochenschr., 1890. XV, 

197. 
Medico-military libraries. Militararzt, Wien, 1890, XXIV, 9; 17; •^S; 35. 
Organization of the Medical Department of the U. S. Array. Militararzt, 

Wien, 1890, XXIV, 105; 113. 

1891 . The health of Napoleon I during the Russian campaign of 1812. Militiirarzt. 

Wien. 1891, XXV, 65-08. 



12 History of Military Medicine 

Recruiting in the United States Army. Militararzt, Wien, 1891, Nos. lS-19. 
The military medicine of ancient Carthage. Militararzt, Wien, 1892, XXVI, 

17-20. 
1893. Examinations for admission to the Medical Corps, U. S. Army. Militararzt, 

Wien, 1893, XXVII, 49-52. 

1895. The development of recruiting service; past and future, Wien. klin. Wochen- 

schr., 1895, VIII, 757-760. 
Did the armies of ancient Egypt have an organized medical service? Wien. 

klin. Wochenschr., 1895, VIII, 924. 
The medical personnel of the British Army. Samariter, MUnchen, 1895, I, 

No. 23-24. 
Recruiting of armies in old times, Leipz. Tagebl., Sept. 5. 
Voluntary nursing in the wars of antiquity. Ztschr. f. Krankenpflg., Berl. 

1895, XVII, 55-58. Also Wien. klin. Wochenschr., 1895, VIII, 9. 

1896. Comparison of the military hygiene of the Homeric period with that of today. 

Vrtljschr. f. offentl. Gsndtspflg., 1896, Hft. 1. 
Losses in war. Ztschr. f. Krankenpflg., Berl., 1896, XVIII, 41; 66; 89; 116; 

140; 163; 185; 211. 
Medical personnel of the Russian Army. Samariter, Miinchen, 1896, I, 

Nos. 8 et seq. 
Mortality and morbidity in the larger European armies in the time of peace. 

Mil. Rundsch., 1896, Hft. 3. 
Nursing at the battle of Leipzig. Leipz. Tagebl., 1897, March 9-18. 
Precursors in charitable nursing. Reichs. Med. Anz., Leipz., 1898, XXIII, 
161-164. 

1897. Cremation in the Homeric poems. Janus, Amst., 1897-8, II, 248-251. 
When did the first gunshot wounds occur.'' Heilkunde, Wien, 1896-7, I, 

502-505. 

1898. Military hygiene in the American and Spanish Armies. Centralbl. f. allg. 

Gsndhtspflg., Bonn, 1898, XVII, 242; 303. 
Schiller's early experience as an army surgeon. Wien. med. Wochenschr., 
1898, XLVin, 1027; 1090; 1131. 

1899. On a charitable aid from the animal kingdom. [History of the use of dogs in 

rescue of the wounded.] Wien. med. Wochenschr., 1899, XLIX, 2251; 
2291. 

1900. Medical service of the British Army. Centralbl. f. allg. Gsndhtspflg., Bonn, 

1900, XIX, 19-33. 

1901. Military medicine in the 16th century. Janus, Harlem, 1901, VL 68; 123; 

178; 253; 309; 366. 

It is clear from the above layout that Frolich was assembling mate- 
rials for a book up to the year of his death; but, given the insufficient 
knowledge of his time, he sometimes committed himself to glittering 
generalities, and his conclusion that Homer was himself a military 
physician did not win the acceptance of the German classical scholars. 

Beginnings of Exact Documentation 

Meanwhile, during the second half of the nineteenth century, individ- 
ual books of a more exact and precisely documented kind had begun to 



Antiquity, Including Greece 13 

appear, e.g., the histories of the medical establishment of the Prussian 
Army by A. L. Richter (1860)i5 and C. J. Prager (1 864-5), ^^ and the 
massive history of the development and status of military medicine in 
European countries by Emil Knorr (1880),^^ a major of the Prussian 
General Staff, These works, bristling with dates, statistics and footnote 
references to the literature and the oflBcial publications of governments, 
afford early instances of the kind of elaborate documentation now re- 
quired in military history. To this genre Frolich himself contributed 
one admirable example, viz., his history of the medical department of 
the Saxon Army (1888), which is based upon state documents. 

Myrdacz 

In 1898 Paul Myrdacz, a staff surgeon in the Austro-Hungarian 
Army, published a huge volume containing separate histories of the 
existing medical establishments of Austro-Hungary, Germany, Italy, 
Russia, and France, with medical histories of the Crimean War (1854-6), 
the Italian Campaign of 1859, the Danish and Austro-Prussian Wars 
of 1864 and 1866, the Franco-Prussian War (1870-71) and the Russo- 
Turkish War (1877-8).^^ This is a reference book of great value, par- 
ticularly as to medical statistics of the principal European wars of the 
nineteenth century. It contains a chronological table of the principal 
events in the development of the medical department of the Austro- 
Hungarian Army, by S. Kirchenberger, which is again based upon 
government documents. 

Kohler 

In 1899 Albert Kohler, a Prussian staff surgeon, published, under 
the auspices of the Kriegsministerium, an elaborate series of biographies 
of German military surgeons and medical officers of the seventeenth and 
eighteenth centuries, which was further extended, to cover the whole of 
the nineteenth century, bj' Kohler, Bock, Hasenknopf and Kimmle 
(1901-4).^^ These studies were the basic material for Kohler's short 
illustrated book, "Essentials of the History of Military Surgery" 
(1901), ^'^ which, as including an outline of the history of military medi- 
cine, is the handiest manual yet published. The treatment is concise 
and attractive, and, while exception may be taken to the excess of 



" A. L. Richter: Geschichte des Medicinalwesens der Koaigl. Preu3sischea Armee. 8^. Erlaageu, 
1880. 

" C. J. Prager: Das preussische Mililar. Medicinalwesen, 8'. Berlin, 1864, 2. AuQ. 8°. Berlin, 1875. 

" E. Knorr: Entwickelung und Gestaltung des Heeres-SanitAtswesens der europ&ischen Staaten, 
8". Hannover, 1880. 

" P. Myrdacz: llandbuch fur k. und k. Miiitararzte, roy. 8°. Wien, 1898, II. 

'» Ver6ffentl, a. d. G«b. d. Mil.-San.-Wesens, Berl., Heft 13, 1899: Heft 18, 1901: Heft 24, 27, 1904. 

*" Koehler: Grundriss einer Geschichte der Kriegschirurgie (Bibhothek von Coler, vol. 7) 80 
Berlin, 1901. 



14 History of Military Medicine 

Germanic data, the work is otherwise very reliable. The preponder- 
ance of German writings on our subject is easily explained by the 
essentially military character of the German and Austrian empires up 
to the European war. In 1855 Dreyer made a statistical study of 831 
books on military medicine, and of these, 369 (48 per cent) were German, 
187 English, 163 French and 54 Russian.^^ In Germany even medical 
students and theologians have sometimes been moved to investigate 
the history of military medicine, and, as we have seen, the bulkiest and 
most elaborate contribution up to 1880 was made by an oflScer of the 
Prussian General Staff. 

CahanSs 
In 1918 Dr. Augustin Cabanes published a most interesting and 
valuable book, entitled Chirurgiens et blessSs a travers Vhistoire (Paris, 
1918). As editor of the Chronique medicale, Cabanes had been hitherto 
the collector and amusing raconteur of the medical anecdotes and "in- 
discretions" of history, but in this large and well-illustrated book he 
appears as a very capable historian, carefully documenting his material 
everj^where and maintaining a just balance between French, English, 
German and other sources. The work is really an elaborate history of 
military medicine, attractive by its easy communicative style, its 
unique illustrations (225 in number) and the intelligent use which the 
genial author has made of the documentary material. Of special interest 
are the facsimile reproductions of French public documents of the 
Napoleonic period, e.g., the earliest printed commissions of medical 
officers, admissions to hospital, certificates of discharge, etc. 

Miscellaneous Contributions from Continental Europe 
On the continent of Europe, where nations and races of the most 
disparate type are contiguous and the possibility of war has been always 
imminent, the subject of military medicine and its history has been 
more closely studied than in detached, isolated countries like Great 
Britain or the United States. Apart from the larger works above 
mentioned, there is a considerable amount of pamphlet and periodical 
literature, the titles of which will be found in the Index Catalogue 
(1-3 series) and in the manuscript files of the Surgeon General's Library 
under the headings already given. Brief mention may be made of such 
outstanding historical studies as those of Billroth on the treatment of 
gimshot wounds (1859) and of railway transportation of the wounded 
(1874), of Gurlt on international nursing in wartime (1873), and on 150 
years of military medicine in Prussia (1875), of Virchow on the progress 
of military medicine (1874), and the valuable essays of Rene Briau 

" Dreyer: op. cil 



Antiquity, Including Greece 15 

(1866) Auguste Corlieu (1892) Wilhelm Haberling (1910-19) and Andrea 
Corsini (1916). SudhoflF's Catalogue of the Dresden Hygienic Exhibi- 
tion (Historical Section, 1911) and his learned study of care of the 
wounded through the ages (1917) are of basic importance. Meyer- 
Steineg's admirable essay on Greek and Roman hospitals (1912) con- 
tains descriptions and very understandable plans of the Roman military 
hospitals at Carnuntum and Xovaesium.^^ 

English Sources 

The "Notes towards the History of the Medical Staff of the English 
Army prior to the Accession of the Tudors" (1873) by Sir W. R. E. 
Smart, R.N., were translated by Frolich, liberally utilized by Knorr, 
and followed in the historical sketch of A. A. Gore (1879)." A good 
account of the later history of the Army Medical Staff is that of P. A. 
Young (1898).^^ Sir Thomas Longmore's treatise on the transport of 
the sick and wounded (1868) is rich in historical details, and his study 
of the medical conduct of the Crimean War (1883) is the best critical 
summary of the subject. Other valuable contributions are the short 
history of English military surgery by J. Young (1913),^^ H. A. L. Howell 
on care of the sick and wounded during 1715-48 (1914), ^^ and Sir An- 
thony Bowlby's resume of British military surgery from Hunter to the 
European War (1919)." The study of the Moghul campaigns (1909)28 ^y 
Col. T. H. Hendley, Indian Medical Service is unique of its kind. The 
"Medical History" of E. T. \Yithington (London, 1894) contains three 
valuable chapters (pp. 74; 115; 221) based upon original research in 
non-medical writings. 

American Contributions 

These relate mainly to the history of the Medical Department of 
the United States Army, including the medical histories of the different 
wars which have been imposed upon our government. Worthy of 
especial note are: 

Browx (Harvey E.) : The Medical Department of the United States Army from 
1775 to 1873. 8°. Washington, 1873. 

Barriger (John W.) : Legislative History of the Subsistence Department of the 
U. S. Army, 1775-1876. 8°. Washington, 1876. 

Hamersley (f. H. S.): Complete Regular Army Register (1779-1879) 8°. Washing- 
ton, 1880, 351-379. 

IxGERSOL (L. D.): History of the War Department. 8°. Washington, 1880, 210-^58. 

»Th. Meyer-Steineg: Jena, med.-histor. Beitr., 1912. Heft 3. 34-45. 

" A. A. Gore: The Story of our Services under the Crown. 8°. London, 1879. 

2* P. A. Young: Edinb. M. J., 1898, n. s., iv, 11-20. 

" J. Young: J. Roy. Army Med. Corps, Lond., 1913, xii, 484-489. 

" H. A. L. HoweU: Ibid., 1914, xiii, 320; 455. 

n Sir A. Bowlby: Brit. M. J., Lond.. 1919. L 205-212; or: Lancet. Lond.. 1919 ,1, 285-290. 

"T. H. Hendley: Brit. M. J., 1909, II, 374-377. 



16 History of Military Medicine 

HoFF (John Van R.): Resume of the history of the Medical Department, U. S. 

Army, 1775-1899. J. Ass. Mil. Surg. U. S., Carlisle, Pa., 1901-02, x, 347-398. 
Thian (Raphael P.): Legislative History of the General Staff (U. S. A.) 1775-1901. 

8°. Washington, 1901, 362-439. 
Kean (J. R.) : The Army Medical Department. J. Am. M. Ass., Chicago, 1904, 

xlii, 1216; 1287; 1352; 1418; 1491. [Reprinted.] 
Owen (William O.): The legislative and administrative history of the Medical 

Department, U. S. Army, during the Revolutionary War (1776-1786). Ann. 

Med. History, N. Y., 1917-18, I. 198; 261; 342. [Reprinted.] 

Chronological arrangement of Congressional legislation, 1785-1917. 12". Chi- 
cago, 1918. 
Duncan (Louis C): The Medical Department of the U. S. Army in The Civil War. 

8°. Washington, 1914. 

The reports of Col. John S. BilHngs on miHtary medicine in Europe 
(1882) and of Brig. Gen. Alfred A. Woodhull on the Medical Department 
of the British Army (1894) are valuable. On the whole, the best piece 
of original research is that of Col. Charles L. Heizmann on military 
sanitation in the sixteenth, seventeenth and eighteenth centuries (1893; 
reprinted 1917)^^; which, like the chapters in Withington's History, is 
based upon data from secular writings and the personal memoirs of great 
commanders. An accurate, compact, and readable summary of the 
history of military medicine is that of Col. Weston P. Chamberlain, M.C, 
(1917, reprinted 1919).3'> 

Histories of Medical Departments of Armies 

For those not already mentioned, consult the Surgeon General's 
Catalogue, first, second and third series, sub voce "Army" (and sub- 
divisions). 

Medical Histories of Campaigns and Wars 

These are of two kinds, viz., personal memoirs and historical narra- 
tives by prominent medical ofl5cers, usually based upon recollection; 
and the official histories authorized and published by governments 
which, in the best examples, are based upon documentation. Examples 
of the first species are the "Apology and Treatise" of Ambroise Pare 
(1585), Thacher's "Military Journal" of the War of the Revolution 
(1827), the military memoirs of the elder Larrey (1812) on the Napoleo- 
nic Wars, of Mann (1816) on the war of 1812, of Chenu (1805) and von 
Hiibbenet (1871) on the Crimean War, of Chenu on the Italian and 
Franco-Prussian Campaigns (1869; 1874), of Pirogoff on the Crimean, 
Franco-Prussian and Turco-Serbian Wars (1859-79), and such books 



" C. L. Heizmann: J. Mil. Serv. Inst. U. S. Governor's Island, N. Y. H., 1893, xiv, 709-738. Re- 
printed in: Ann. Med. History, N. Y., 1917-18, I, 281-300. 

">W. P. Chamberlain: Boston M. & S. J.. 1917, clxxvi. t79-t86. Reprinted in: Smithson. Inst. 
Rep. 1918, Wash , 1919. 235-249 



Antiquity, Including Greece 17 

as Lettermann's Medical Recollections of the Army of the Potomac 
(1866) and the Personal Memoirs of John H. Brinton (1914). Accurate 
and painstaking research is evidenced in such studies as those of Fried- 
rich Loeffler on the Danish and Austro-Prussian Campaigns (1864r-7; 
1868) and of Emil Knorr on the Turco-Servian War (1883), which were 
prepared under government auspices, and also in the monographs on the 
Revolutionary, Mexican and Civil Wars by Col. Louis C. Duncan 
(1914-21), and the above mentioned histories of continental European 
wars by Paul Myrdacz. 

As applied to the formal and official "medical histories" of wars 
issued by governments, the term "history" is usually a misnomer, 
since all the larger public documents of this kind are, in the main, made 
up of compilations of medico-military statistics, analyses of medical 
and surgical cases, studies of communicable diseases and other profes- 
sional matters. This is largely true of the official medical histories of 
the Crimean, Civil, Franco-Prussian and Pan-European Wars. The 
great Medical and Surgical History of the Civil War, prepared by Wood- 
ward, Otis, Huntington and Smart (1870-88), does contain, however, 
valuable histories of the development of hospital construction, transport 
and surgical instrumentation, and a remarkable series of personal re- 
ports on battles and military operations by individual medical officers, 
which have been found very useful, even by the secular historians of 
this war. Up to the European war this latter collection has been unique, 
for, as we have seen, such battle reports have usually been elsewhere 
published as individual contributions by the medical officers themselves. 
Inasmuch as such reports have commonly been written in the past from 
the pocket diaries and note-books kept by medical officers in campaign, 
the necessity for careful documentation has latterly arisen, and for the 
following reasons. "Memory is a sieve," fallible as the human mind 
itself, and our psychologists have shown, to their own satisfaction at 
least, that few persons can describe an exciting event exactly as it 
occurred. Exact or even approximate dates of occurrences are partic- 
ularly apt to slip their cables, whence careful heads of families v/ere 
accustomed, in old times, to keep definite records of births, christenings, 
marriages, deaths and so forth, in the family Bible or private diary. 

Newton is said to have forgotten some of his own mathematical dis- 
coveries, although he could always, on occasion, give the successive 
steps which led up to them; Sir Walter Scott is said to have wept on 
hearing one of his own songs, the authorship of which he had forgotten; 
and Clerk Maxwell, one of the keenest minds the world has ever known, 
made some very faulty computations in the kinetic theory of gases, 
through lapse of memory, at a time when his brain was tired out by 



18 History of Military Medicine 

illness and approaching death. Physicians who only remember the 
approximate dates of articles they have written, or that someone else 
has written, are constant clients of medical librarians. Separate mili- 
tary reports of the same occurrence by different observers have been 
found to cross cables as to dates, statistics and close renditions of fact, 
and some of them have been shot through and through as to reliability 
when subjected to careful analysis. Documentation from the records, 
such as is now required by the General Staff for the administrative and 
non-professional portions of our medical history of the European War 
is therefore not "a Gaulish and a German thing" but something con- 
ditioned by the necessity of bringing history up to scientific standards of 
accuracy by holding the writer accountable and responsible for his 
statements. The reason for its existence is contained in the fine dis- 
tinction made between culture and science by our greatest classical 
scholar: "Culture is the substance of things which a gentleman has 
forgotten." 

Of actual or prospective medical histories of the European War, 
three volumes of the German have been published to date and are con- 
fined to purely professional and scientific material. As indicated by 
the prospectus, battle operations and administrative mechanism will 
not be a feature of this history. The preliminary pamphlets and vol- 
umes issued by the Medical Research Committee (National Health 
Insurance) suggest that the English history will be in the same trend. 
The medical history of American participation, now very properly 
entitled "The Medical Department of the United States Army in the 
European War," will deal with administrative and tactical, as well as 
professional, material. Under the editorship of Col. Charles Lynch, 
M. C, two volumes of this history are already in the press. 

Lives of Eminent Military Surgeons and Medical Officers 
The biographies of Ambroise Pare by Malgaigne (1840), Le Paulmier 
(1884) and Stephen Paget (1897) are all of extraordinary merit. The 
recent "Life and Times" by Dr. Francis R. Packard (New York, 1921) 
contains an excellent translation of Pare's Apology and Journeys, 
interesting for their grim pictures of war as it was in the sixteenth cen- 
tury. M. Roth's Vesalius (Berlin, 1892) is perhaps the most wonderful 
of all medical biographies; the illustrated volume by Dr. J. M. Ball 
(St. Louis, 1910) is excellent and reliable for those who do not read 
German. The best life of John Hunter is that by Stephen Paget (Mas- 
ters of Medicine, London, 1897), and the same may be said of Paul 
Triaire's fine book about Larrey (Tours, 1902), of whom the best account 
in English is unquestionably that of Dr. J. C. Da Costa (1906).^^ The 

»' J. C. Da Costa: Johns Hopkins Hosp. BuU., Bait., 1906. xvii. 195-215. 



Antiquity, Including Greece 19 

Prussian surgeons general and other German officers have been well 
taken care of in the collection of Kohler. The three-volume life of 
Helmholtz by L. Koenigsberger (Braunschweig, 1902) has been Eng- 
lished by F. A. Welby (Oxford, 1906). Of Anglo-Indian officers. Sir 
Joseph Fayrer's Recollections (Edinburgh, 1900) is interesting for its 
details about the Mutiny; his life of Sir James Ranald Martin (London, 
1897) and the sketches in the History of the Indian Medical Service by 
Lieut. Col. D. G. Crawford (Calcutta, 1914) are also to be recommended. 
Of American references, the biographies of John Morgan by M. I. 
Wilbert (1904), of William Beaumont by Jesse S. Myer (1912), of Letter- 
man by Lieut. Col. B. A. Clements (1883), ^2 of Walter Reed by Howard 
A. Kelly (2d ed., 1913), and of George M. Sternberg by Mrs. Sternberg 
(1920) need only be mentioned. "The Surgeon Generals of the Army" 
by Major James E. Pilcher (1905), is a standard source of reference. 
The "Personal Recollections" of Eunice Tripler (privately printed, 1910) 
is, like the Sternberg biography, a pleasant record of army life by the 
widow of a celebrated medical officer. 

Exhibitions of Military Medicine 

Exhibitions of military medicine have been a feature of all interna- 
tional expositions, from the time of the Paris Exposition (1867) and its 
successors (1878, 1889, 1900) to the Centennial (1876) and the local 
American expositions at Chicago (1893), Buffalo (1901) and St. Louis 
(1904). A report on the English exhibit of military medicine at the 
Paris Exposition of 1867 was rendered by Sir Thomas Longmore. The 
exhibit illustrating the history of military medicine at the International 
Hygienic Exposition at Dresden, in 1911, was a new departure. Here 
the subject was illustrated from the Assyro-Babylonian period to the 
middle of the nineteenth century by inscriptions, placards, pictures, 
books and ojDJects of all kinds. 

During the World War no less than six historical exhibitions of this 
kind were held, in Berlin, London, Paris and Washington. The first of 
these was held in the parliamentary buildings at Berlin in 1914 and fol- 
lowed the Dresden exposition in the tendency of its historical exhibit. In 
the following year (1915), Dr. Norman Moore exhibited a number of old 
English texts of military medicine and surgery before the Medical 
Society of London and a similar demonstration was made to the Royal 
Medical Society (Historical Section) in the same year. In 1916 an 
exhibit of pathological specimens from the war was attached to the 
Historical Museum of the Service de Sante at Val de Grace, and a 
similar exhibition by the Royal Army Medical Corps was opened at 



«B. A. ClemenU: J. MU. Serv. lost.. Governor's Island, N. Y. H., 1883. iv, 250-287. 



20 History of Military Medicine 

the Museum of the Royal College of Surgeons, London, on October 11, 
1917. In 1918 an exhibit of books and curiosities of the war was made 
in the Hall of the Surgeon General's Library under the direction of Col. 
C. C. McCulloch, Librarian, S. G. O.^^ 

Medico-Military Periodicals 

The titles of the earliest periodicals devoted to military medicine 
are subjoined in chronological order of appearance in the different 
countries : 

I78!i. France: Journal de medecine militaire. Publie par ordre du roi, v. 1-7. 

Paris, 1782-8. 
1789. Austria: Bibliothek der neuesten medizinisch-chirurgischen Literatur filr 

die k. k. Feldchirurgen., v. 1-4. Wien, 1789-92. 
1816. Germany: Magazin fiir die gesammte Heilkunde, mit besonderer Riicksicht 

auf das Militar-Sanitats-Wesen im koniglich-preussischen Staat. v. 1-24, 

n.F., V. 1-42. Berlin, 1816-48. 
1823. Russia: Voyenno-meditsinskii Journal [Medico-military Journal] v. 1-240. 

Petrograd, 1823-1914. [Current at outbreak of European War.] 
1848. Belgium: Archives medicales beiges. Organe du Corps sanitaire de TArmee, 

Bruxelles, 1848-1921. 
1853. Italy: Giornale di medicina militare, v. 1-32, Firenze, Roma, 1853-84. 

[continued as: Giornale medico del Regio Esercito, Roma, 1885-1921]. 
1864. Spain: Revista de sanidad militar espanola y extranjera, v. 1-4. Madrid. 

1864-7. 

1876. Sweden: Tidskrift i militar Halsovard. Stockholm, 1876-1921. 
Portugal: Gazeta dos hospitaes militares, v. 1-8. Lisbon, 1876-84. 

1877. Holland: Nederlandsch Militair-geneeskundig Archief. [Various places], 

1877-1921. 
1891 . United States: Transactions [Journal] of the Association of Military Surgeons, 

1891-1906. Continued as: Military Surgeon, Washington, 1907-21. 
1903 Great Britain: Journal of the Royal Army Medical Corps, v. 1-25. London, 
1903-21. 

Medico-Military Libraries 

In 1781 the military hospital at Gumpendorf, Austria, was turned 
into a hospital school for field surgeons, and provided with a medical 
library during 1783-5. The Prussian Pepiniere, for instruction of 
medical officers (founded 1795), was furnished with a medical library by 
Surgeon General Goercke in 1798. The Medico-Military Academy at 
Petrograd (founded 1798) acquired a medical library which was, for a long 
time, the largest medico-military library in the world (180,000 volumes, 
with 257 periodicals, and an annual budget of 600 rubles). This collec- 
tion, once the second medical library of the world, has latterly been out- 
paced in number of volumes by the Surgeon General's Library. The 
Library of the Medico-Chirurgical Academy at Dresden (founded 1815) 



" A full account of these exhibitions is given in Military Surgeon, Wash., 1918, xlii, 351-359. 



Antiquity, Including Greece 21 

was absorbed by the National Medical Collegium of Saxony in 1864, 
when the Saxon Army Medical School ceased to exist, but another 
collection, confined to books on military medicine, was started by a 
donation of Staff Surgeon Glinther in 1853 and was catalogued by 
Frolich in 1877. The Library of the School of Military Medicine at 
Val de Grace (founded 1850) was catalogued (176 pp.) in 1861. The 
Library of the English Army Medical School at Netley (1860) was 
founded in 1862, but the collection goes back to the earliest times. The 
Surgeon General's Library at Washington, now surpassed only by the 
Library of the Paris Medical Faculty in number of volumes, was, in 
1836, a modest office outfit of medical books in Surgeon General Lovell's 
room, and was developed to its present status (650,000 items) by Col. 
John S. Billings during his Washington period of active duty in the 
Army (1865-95), and by his successors. The Index Catalogue of this 
Library is now in its fortieth volume (1880-1921). The library and 
reading room of the Scuola d'applicazione di sanita militare at Florence 
was opened on January 1, 1883. 



CHAPTER II 
Military Medicine in Antiquity 

Prehistoric 

In prehistoric time we do not find, do not expect to find, organized 
armies. Cave man was occupied with hunting, fishing, herding, and 
such warfare as he made with stocks and stones, flint arrows, spears 
and axes, was in the nature of hand-to-hand combats with his own 
kind or with gigantic animals. In these conflicts one principle was 
forced upon his attention; he won out as much by his wits as by native 
strength; the best brains were the winning brains. Three great English 
physiologists have, in fact, devoted their lives to a proof of the proposi- 
tion that the coordination and integration of the nervous and chemical 
mechanisms regulating the animal or human organism are the prin- 
cipal factors in its evolution and development. As Gaskell puts it: 
"It is not size, it is not strength, that has conferred the great advantage 
in the struggle, but acuteness." 

Four paintings exhibited by Paul Jamin in the Parisian Salons of 
1885-1903^ illustrate some of these phases in prehistoric human existence. 
One represents a number of cave men fighting over a woman; another a 
group of men fleeing in the snow before an advancing mammoth; a 
third a group of women and children looking on while a primitive artist 
executes one of the gigantic mural paintings in a prehistoric cave; a 
fourth, a savage chieftain, clad in skins, with casque and spear, appalled 
at the discovery of his wife in the clutches of a lion at the mouth of a 
cave. All that we know of early man's life is here: his realization of the 
need of organizing means of defense for himself, his family and his 
fellows against inevitable catastrophes; lust of power and possession 
as the cause of war; the evolution of union and cooperation in the defense 
of a social group against formidable enemies of gigantic size; and the 
development of the arts by peace. In the face of primitive social forces 
like these such motives as the cherchez la fennne in the Trojan and other 
wars (indicated with frank indecency in the third satire of Horace) 
dwindle into relative insignificance. Visualize prehistoric man as 



'Rev. de I'ficole d'anthrop, de Paris, 1903. xiii. pi. ii. v. 
22 



Antiquity, Including Greece 23 

hunting, first singly, an Ishmaelite with his hands against all his fellows, 
then in couples, then in packs; assume a dispute over spoils of the chase 
or strayed animals from the herd between two men of different gangs; 
then an encounter, with eventual participation of all the gangsters. 
We have at once a primitive instance of Pirogoff's theory of war as a 
communicable disease, a "traumatic epidemic," not different from what 
was to happen hundreds of times later everywhere, "from China to 
Peru," in Scotland or Corsica, or among early settlers and mountaineers 
in our own country. A sense of the value of organization, discipline 
and leadership probably arose when the sessile people who cultivated 
wild wheat on the fertile plains became domesticated and were assailed 
by the hardy nomadic hunters and herdsmen, whose commissariat of 
milk and milk products travelled with them. Without organized mili- 
tary forces, the tamed went down before the untamed; homo domesticus 
was overcome by homo ferus, with the amusing sequel that wherever a 
conquering race settled down on conquered territory, they became 
assimilated to the civilization of the conquered people through inter- 
marriage with their women. But that even barbaric communities 
could maintain peace with honor, maintaining their individuality on 

the Scotch principle, 

" Here 
Ye maunna think to domineer," 

is evident from the memorable passage in Tacitus about the Chauci, 
which the great historian intended as an ironical rebuke to the aggres- 
sions of imperial Rome: 

They are the noblest of the German tribes, and so constituted as to prefer to 
protect their vast domain by justice alone; they are neither grasping nor lawless; 
preferring quietude and seclusion, they provoke no wars and dispatch no raiders on 
marauding forays; the special proof of their sterling strength is, indeed, just this: 
that they do not depend for their superior position upon injustice; yet they are ever 
ready with arms, and, if circumstances require, with armies, with men and horsemen 
in abundance; so, while they uphold peace, their military reputation does not suffer 
(Germania, 35). 

In encounters between West-European barbarians in the historic 
period it was usually the custom to drag the wounded into safety and 
shelter, where possible (Tacitus).^ But, as we shall see, definite organi- 
zation for the rescue and care of the wounded has seldom been fostered 
except by experienced commanders of unique military genius. The 
great Mongol raids of the Middle Ages, the most devastating on record, 



•Of the Germanic tribes, Tacitus eays " they carry off their dead and wounded even in drawn battles 
(corpora suorum eiiam in dubiis proeliis referant. — Germania, 6). In the encounter between the 
Caledonians and Romans, in the Agricola. he tells how the scattered Hritons, amid the tribal wailing, 
began to drag off their wounded and to chock up on those unhurt (Britanni palantes mixloque 
virorum mulierumque ploralu trahere vulneralos, voeare inlegros. — Agricola, 38). 



24 History of Military Medicine 

sweeping all Asia and half of Europe, were characterized by massacre 
of the enemy's wounded and fatalistic Oriental indifference to their 
own. These are facts in anthropology. 

The evolution of the art of medicine in primitive society is beautifully 
indicated in the ancient treatise of Celsus as follows: 

Some of the sick, on account of their eagerness, took food on the first day; some, 
on account of loathing, abstained; and the disease, in those who refrained, was more 
relieved. Some ate during a fever, some a little before it; others after it had subsided, 
and those who had waited to the end did best. For the same reason, some at the 
beginning of an illness used a full diet, others a spare, and the former were made 
worse. Occurring daily, such things impressed careful men, who noted what had 
best helped the sick, and began to prescribe them. In this way, medicine had its 
rise from the experience of the recovery of some, of the death of others, distinguishing 
the hurtful from the salutary things.' 

The disease to which prehistoric man was most exposed was arthritis 
deformans, the "cave gout" of Virchow, which, to an appalling degree, 
affected alike the primitive inhabitants of Europe and the Egyptians on 
the banks of the Nile, as evidenced in innumerable prehistoric skeletons 
and mummies. The Lake Dwellings represent, in some measure, the 
efforts of the cave men to get above and away from the evil effects of 
sleeping on the damp ground.* 

Egypt 
In Egypt, the mother of civilization, we find warfare by means of 
organized armies already a going concern. How recent the "antiquity" 
of Egypt we may judge by the dictum that if man's existence in space 
and time be represented by the circuit of a clock from XII to XII, 
then palaeolithic man occupied the complete circuit in time up to XI, 
neolithic man all that remains up to the last half minute, which small 
interval represents the 8,000 years in the sublunary existence of historic 
or "civilized" man and his forbears.^ How highly specialized the 
Egyptian civilization, how much like our own in many curious respects, 
may be gathered from a glance at some of the exhibits listed in Sudhoffs' 
Dresden Catalogue: 



Celsus: De re medica. Proaemium. Cited by Sir William Osier in his SiUiman Lectures (Yale 
Press, 1921) . 

«Sudhoff: Ann. Med. History, N. Y., 1917-18, i, 111-112. Tacitus (Germania, 46) describes the 
Fenni, a Slavic or gypsy tribe, as sleeping on the damp ground (cubili humus) . In travelling through 
lower Hungary in 1814, Dr. Richard Bright (of Bright's disease) found the same people living in 
dugouts: 

"Now I believe the Troglodytes of old. 
Whereof Herodotus and Strabo told. 
Since everywhere, about these parts in holes, 
Cunicular men I find and human moles." 

Bright: Travels from Vienna through Lower Hungary. London, 1818, 615. 

' B. Holmes and P. G. Kitterman: Medicine in Ancient Egypt, Cincinnati, 1914, 7. 



Antiquity, Including Greece 25 

e. g., baking bread; a market, with separate stands for fish, vegetables, etc.; brewing 
beer; making a fire with bellows; people in bed; cosmetics, toilet articles and vanity 
sets; a barber clipping hair; razors; a bath-room; accouchement of queen by four 
midwives; clitoridectomy; wrestling matches; secretaries taking dictation; ship- 
building; a transport barge or lighter; four statues of physicians; and (220 B. C.) 
complaint of a Greek lady to Ptolemy on being parboiled in a public steam bath.' 
A box of Egyptian toys, recently excavated from a tomb by the Metropolitan Museum 
of Art, contains a model bakery, stable, carpenter's shop, slaughter-house, etc.^ 

Life in this antique world was organized about as follows : At the top 
were the learned class, with the temple as the repository of records and 
center of knowledge. Lower down were the farmers, herdsmen, mer- 
chants and artisans, with a great mixed substratum of servants, slaves, 
gang-laborers, mercenarv' soldiers and sailors. From the primitive 
concept of chief priest as tribal leader and medicine-man was presently 
evolved, through division of labor, a military leader or king, with sub- 
altern commanders and warriors, as the defensive arm;^ and later another 
class, the physicians who were already specialists, in that each applied 
himself to diseases of one part of the body only. The mihtary monarch 
was eventually elected to godhead and was often at odds with the priests 
in consequence. Egj'pt was essentially a matriarchal civilization, pay- 
ing great regard to maternity insurance and child welfare. Each 
district of the country had a military guard of its o^ti, with arsenals or 
barracks, and these guards were, in time of war, consolidated into an 
army, strengthened by mercenary negro troops from the south. Of 
their medical service in campaign, Diodorus Siculus relates (i, 82) : 

On campaigns or other expeditions out of the country, the sick are treated without 
cost to themselves; for the physicians receive compensation from the state and 
practice medicine from a formulary compiled by many learned hands. If, following 
the prescriptions of this sacred book (Embre), they fail to save the patient, they are 
absolved from all guilt; but if they run counter to its directions, they are put to 
death; for the lawgiver opined that few physicians are more competent than a 
system tested by time and compiled by the best. 

As to the organization of the medical profession in Egj'pt, both 
Homer and Herodotus are in agreement. In the Odyssey (iv, 231-232) 
occurs the verse: 

"There every physician excels all other men in [his particular] knowledge; for 
truly, they are of the race of Paeon."' 

• Sudboff: Internationale Hygiene-.\ust«Uung, Dresden, 1911, i, Historische .\bteilung, 3-4-41 
items 1101-1632;. 

' Forbin; Les jouets dans la tombe. Nature. Paris, 1921, 53-59. 
«H. G. Wells: Outline of History. London, 1921, i. 149-162 
' Frolich cites the Voss translation of this Homeric verse, with the reading — 
"Dort ist jeder ein .\rzt und ubertrifft an Erfahrung 
AJle Menschen: den wahrlich sie sind von Geschlechte Paeons." 
which is erroneous. If we may trust Herodotus, the essential feature of Egyptian medicine was a 
specialist for every disease or group of diseases, while every man as a self-appointed doctor (Jeder 
ein Arzl) was characteristic of Assyro-Babylonian medicine. 



26 History of Military Medicine 

Herodotus says (ii, 84) : 

The art of medicine is thus divided among them; each physician applies himself 
to one disease only, and not more. All places abound in physicians; some are for 
the eyes, others for the head, others for the teeth, others for the parts about the 
belly, and others for internal disorders. 

The Egyptians were natural chemists and had a most extensive 
pharmacopoeia, with weighing of drugs by the balance; but their extreme 
specialism of "a doctor for every disease," or at least for each part or 
region of the body, could only result in haphazard therapy. The 
Ebers Papyrus (1550 B. C.) shows them at their best in their knowledge 
of the hookworm and other parasitic affections, of diseases of the eye 
and ear, of the treatment of tumors and abscesses by the knife, and of 
the art of embalming. Trephining was common, as among all ancient 
and primitive peoples. Larrey, in his Memoirs, states that the mural 
paintings and bas-reliefs in the temples at Karnak, Luxor, etc., afford 
abundant evidence of the methodical practice of surgery by the ancient 
Egyptians. ^'^ Circumcision and other phases of genito-urinary surgery 
are clearly depicted on a tomb at Saqquarah, near Memphis (2500 B. C). 
Egyptian surgery was essentially external and rudimentary; their 
knowledge of anatomy was small. The instruments found are usually 
of the Bronze Age; but Plate II in the great album of Lepsius represents 
sword-blades, spear and arrow points as painted blue, which suggests 
perhaps some knowledge of the tempering of iron into steel (Frolich). 
The mummies excavated in Nubia in 1907, prior to the flooding of the 
Assuan Dam, show splinting of fractures by means of palm-fiber band- 
ages, with surprisingly good results and little shortening.^* This 
technique was the origin of the art of bandaging, which was highly 
elaborated by the Greeks and Romans, and to which Oribasius (325-403 
A. D.) devoted no less than seventy chapters. A stele of the Eighteenth 
Dynasty (1580 B. C.) in the Carlsberg Glyptothek (Copenhagen) 
shows the use of a crutch in an obvious case of poliomyelitis. The 
mummies show that syphilis, cancer and rickets were non-existent, 
teeth were uniformly good and free from caries, rheumatoid arthritis 
was of staggering frequency from youth to old age, even in the latest 
dynasties, while Pott's disease (21st Dynasty, 1000 B. C), spondylitis 
deformans, gout, malarial spleen, atheroma of the arteries, mastoid 
disease, pleural and visceral adhesions, necrosis and cranial injuries 
from blows and sword-strokes have been found.'- 



" D. J. Larrey: Memoires de chirurgie militaire, Paris, 1812, ii, 223. 

" For photographs of which, see G. Elliot Smith and F. Wood Jones; The .Archaeological Survey 
of IS'ubia, Cairo, 1910. Atlas to Vol. ii, passim 

" Elliot Smith; op cil.. Vol. ii; also Sudhoff; Dresden Catalogue, 1911, 52-.53 (items 1633-1713). 



Antiquity, Including Greece 27 

Sumer and Akkad 
(Assyro-Babylonian Civilization) 

Between the Tigris and the Euphrates lay the ancient "kingdom 
between the rivers" (Mesopotamia), originally occupied by the mysteri- 
ous Sumerians, the originators of our decimal system of notation, our 
ordinary divisions of time, and the art of writing on clay tablets. On 
account of their enormous wheat yield (Herodotus, i, 193), these fertile 
plains were to be the seat of endless wars, in the course of which a 
mighty civilization of some 5,000 years standing was gradually built 
up. The Sumerians were conquered by the Semitic Akkadians under 
Sargon (2750 B. C), but, in keeping with the anthropological law of 
Lapouge,'^ the conquerors were assimilated by the conquered people, 
and the old Sumerian culture prevailed. In 2100 B. C. all Mesopotamia 
was mastered by the Amorites under Hamurabi, whose capital was 
Babylon. Babylonia then fell successivel}' under the domination of 
the Assyrians under Tiglath Pileser I and III (1100 B. C; 745 B. C), 
with an additional capital at Xineveh; of the Medes and Persians under 
C\Tus (539 B. C); and of the Greeks under Alexander the Great 
(331 B. C.). 

In spite of this constant change of military masters the Assyro- 
Babylonian culture continued to have a natural growth and develop- 
ment up to its inevitable decadence. These wonderful people did much 
for the development of astronomy, had splendid drains and sewers, ^^ 
stone privies, slipper-shaped coffins and fan-shaped tombs, an organized 
system of wet-nursing, long lists of injurious insects and parasites, 
parasols against the heat, fly-flaps against insect pests, hollow tubes 
for sipping beverages, water-wings to teach swimming,^^ and knew the 
Australian crawl. They had a highly organized military service, with 
chariots, archers, light cavalry and infantry tactics in close phalanx 
formation. As their imposing bas-reliefs indicate, a large part of the 
service of their defensive arm was taken up with organized warfare on 
wild animals. In prehistoric times the larger animals of the cat family 
were plentiful all over Europe, as well as in Asia and Africa. Lions 
existed in Germany up to the Neolithic period, in the Balkans up to the 
fourth century B. C, while the panther was common in Greece, Southern 
Italy and Spain up to 1000 B. C., and was usually figured in Bacchic 
processionals on Greek pottery of the later periods. Extermination 



""La lerre est reet^ i)artout aux descendants de ceux qui la cultivaient et ne garde plus que 
es OS de la race siip^rieure qui I'ensanglantait." G. de Lapouge: Rev. d'anthrop.. Par., 1887, xvi, 524. 

'* For the sewerage and water-supply of the ciJes of antiquity, see H. A. Nielsen: Arch. f. Hyg., 
Ber... 1902. xliii, 85-115 

"Sudhoff; Dresden Catalogue, 1911, 21-28 (items 601-1047). 



28 History of Military Medicine 

of these beasts was effected, not by change of cHmate but by man.^^ 
Some of the finest and most reahstic of the Assyro-Babylonian bas- 
rehefs represent Hons transfixed by spears, in the agony of death, with 
spirited scenes of the destruction of wild beasts by archers and spearmen 
in chariots or on horseback. The demons of Assyro-Babylonian 
mythology were usually represented as lion-headed. An ancient carved 
limestone pillar of the Sumerian period (2920 B. C), found at Telloh 
and known as the Stele of the Vultures, shows helmeted warriors with 
extended spears marching in phalanx formation over the bodies of their 
enemies; another detachment with spears at "right shoulder arms," 
headed by the king in a chariot; the god Ningirsu capturing the enemies 
of Lagash in a net; the burial of the soldiers of Eannatum in a common 
trench, with policing of the battlefield by vultures. ^^ 

An Assyrian bas-relief shows the transportation of a gigantic stone 
image by gang laborers hitched to a truck and urged on with whips. 
A bas-relief from Nineveh shows a walled camp, with drinking, bed- 
making and slaughtering of animals in tents. ^^ 

The essential features of Assyro-Babylonian medicine were a demon 
for every disease (our disease germs), prognosis by liver inspection and 
therapy by exorcism and herbal remedies. Contagion was seizure by 
demons; incantation was prophylaxis. Conjurations against mosquitoes 
have been found, and the symbol of Nergal, the Mesopotamian god of 
disease and death, is a fly. The ancient Babylonian custom charac- 
terized by Montaigne as "the whole people as physician" is given in 
Herodotus (i, 80) : 

They bring out their sick to the market place, for they have no physicians. 
Then those who pass by the sick person confer with him about the disease, to 
discover whether they have themselves been afflicted with the same disease as the 
sick person, or have seen others so afflicted; thus the passers-by confer with him, and 
advise him to have recourse to the same treatment as that by which they escaped 
a similar disease, or as they have known to cure others. And they are not allowed 
to pass by a sick person in silence, without inquiring into the nature of his troubles. 

This Main Street variety of communal medicine and group diagnosis 
implies, however, that some of these self-appointed physicians were 
more highly skilled than the rest. As a matter of fact, a number of 
letters by court physicians to Assurbanipal (884-860 B. C.) on clinical 
cases have been deciphered. In the Code Hamurabi (2250 B. C.) 
the statutory fees of physicians are carefully indicated in particular 
cases, as also the penalties for malpractice; e.g., in setting a fracture or 
operating for cataract. Like Egypt Babylonia was a matriarchal 

" Sir H. H. JohnstoD.- footnote to p. 192 of Wells' Outline of History, Lond., 1921, i. 
" For a reproduction of this stele, see Morris Jastrow; The Religion of Babylonia and Assyria. 
Pbila., 1915, pi. xlvi-xlvii. 

" Sudhoff: Dresden Catalogue, items 758-760. 



Antiquity, Including Greece 29 

civilization, and there are no comelier figures in sculpture than those 
representing the mother-goddess Ishtar suckling a child. The rights 
of wives, widows and children, including orphans and adopted children, 
were scrupulously protected by severe penalties in the Hamurabi Code. 

The caduceus as the symbol of the Mesopotamian god of fertility 
(Ningishzida) is found on a green steatite vase from Telloh (4000-3000 
B. C), now in the Louvre. This symbol was later assimilated by the 
Greeks as the emblem of Mercury, the god of commerce, and by the 
Romans as a badge of secrecy and neutrality, with a special herald, the 
caduceator or peace commissioner, for the conduct of peaceful negotiations 
in war time. Varro called the caduceus "the symbol of peace,"^® 
and the fact that it connotes transactions of this character probably 
led to its adoption as a symbol of the non-combatant status of the 
American medical officer and his rights in the zone of advance in war- 
time, under the Geneva Convention. ^^ 

As in Greece or Rome, there were elements of darkness, blood- 
guiltiness and cruelty in Egypt and Babylon, but probably not more 
than in the extensive holocaust of religious martyrs and free-thinkers 
in the sixteenth century, or, scattered over a wider surface, on the 
police-blotters of the larger cities of the world today. 

Israel 

The wars of the Jews occupy no inconsiderable portion of the Old 
Testament, the Apocrypha and the writings of Josephus; the Hebraic 
contribution to military hygiene is an essential part of their remarkable 
work in the early development of preventive medicine. In connection 
with the sojourn in Egypt and the Babylonian Captivity (587-537 B. C), 
the Hebrews undoubtedly acquired much from these ancient civiliza- 
tions and were perhaps influenced in a later period by the convection of 
culture from Greece. In the modern view Moses, as the hygienic 
shepherd of his people (circa 1491 B. C), is only a symbol for the finished 
product of Sumerian-Semitic cult-hygiene (as set forth in the Penta- 
teuch), after a long period of gradual development. Circumcision was 
originally a primitive ethnic (Egyptian) rite,^^ like clitoridectomy, 
"which to date has not been proclaimed a hygienic measure;" and 
"even ritual uncleanness of women under special circumstances is 
ancient property of Greece" (Sudhoff).-^ 

But the Hebrews did do a number of very important things for the 



" "Caiiiiceus pacis siKnum." Varro: De vita populi Romani, lib. ii. 

" F. H. Garrison: Hull. Med. Libr8u-y Assoc, Bait, 1919, ir, 13-16; also, Miutary Suroeon; 
Wash., 1919, xliv, 633-636. 

" Jewish Encyclopaedia, N. Y., 1903, iv, 96-97. 
"Sudhoff: Ann. Med. History, N. Y., 1917-18, i, 114. 



30 History of Military Medicine 

ethical and hygienic well-being of civilized man which cannot be attrib- 
uted to Sumer and Akkad. First of all the best features of their 
moral code, whether of the Old or the New Testament, are intimately 
connected with clean living and constitute a touchstone of all ultimate 
refinement of human character. Their prophets developed that spirit 
of outspoken indignation against social injustice which Wells calls " the 
free conscience of mankind" and which, however latent or apparent 
in iEschylus and Sophocles, was a new thing in antiquity and was not 
a salient trait of the Hellenes. They introduced the weekly day of 
rest as a splint for overworked humanity, a hygienic idea of fundamental 
importance, and they early recognized certain diseases as communicable 
and took effective measures to prevent them. The book of Leviticus 
(xiii-xv) is thus the basic text of a phase of preventive medicine which 
was absolutely unknown to the Greeks. The Jewish priests were true 
hygienic police, supervising the segregation of lepers and venereal carriers, 
but physicians were a class apart, and there is no evidence that priests 
ever attended individual cases of illness. In the Assyro-Babylonian 
cult, as Sudhoff tells us, "whoever was defiled by issuhu (leprosy) was 
banished into the wilderness . . . but in the Old Testament (Leviticus 
xiii), we have the methodic investigation of the leper by the priest, who, 
according to the diagnosis, isolated the patient temporarily, or per- 
manently."-^ The external signs of leprosy are given in minute detail 
in verses 2-44; an ascertained leper was expelled from the community 
(44-46), condemned to civil death, his clothes were burned, if contami- 
nated (47-52), or washed, if not (53-59), while a suspected house was 
closely examined and, if contaminated, was destroyed (Lev. xiv, 34-53). 
The fifteenth chapter of Leviticus, dealing with the "uncleanness" of 
men and women "in their issues," exacts the same rigid regimentation 
in cases of urethritis (gonorrhoeal or other). The plague of Baal Peor. 
caused by sexual intercourse with the Midianitish women (Numbers 
xxv), was followed by a Sicilian Vespers of Midianites, which, after the 
fanatical fashion of antiquity, was extended to all males and to all 
females who were not virgins (Num. xxxi). " Purification " (disinfection) 
in the Mosaic ritual was accomplished by the use of fair water, or by a 
mixture of "cedar wood (juniper), scarlet and hyssop," or by actual 
incineration (Lev. xii-xv, passim). 

In the sanitary regulation of diet and water supply Leviticus xi 
and Deuteronomy xiv are again extraordinarily forward. Prehistoric 
and primitive man, like the infant, was apt to swallow everything that 
seemed edible, with the same untoward results which Celsus noted in 
the evolution of dietetics in disease. The Mosaic code pronoimced as 

"Sudhoff: op. ciU 115. 



Antiquity, Ixcluding Greece 31 

edible all ruminant animals with cloven hoofs (herbivora), all fish with 
fins and scales, all birds not feeding upon carrion, while ordinary ungu- 
lates and tardigrades, poisonous fish (devoid of fins and scales), all 
creeping things (reptiles and batrachians) and all unclean birds were 
rigorously prohibited, as also any water touched by their carcasses 
(Lev, xii, 3-43). Fat and blood were taboo (Lev. vii, 26; xix, 26), 
and it was forbidden to "eat of anything that dieth of itself" (Lev. 
xi, 9) or "any flesh that is torn off beasts in the field" (Exodus xxii, 31). 
Water or utensils contaminated by dead or unclean animals could not 
be used (Lev, xi, 32-39), and any open, uncovered vessel in a tent con- 
taining a corpse was regarded as unclean (Num. xix, 14, 15).^* Here, 
then, we have a highly effective scheme of sanitation for hot climates, 
which was never observed or recorded by the Greeks and the Romans. 
The same intelligence and forethought is apparent in the remarkable 
passage in Deuteronomy (xxiii, 9-14) on the policing of a military camp : 

9. When the host goeth forth against thine enemies, then keep thee from every 
wicked thing. 

10. If there be among you any man that is not clean by reason of uncleanliness 
that chanceth him by night, then shall he go abroad out of the camp, he shall not 
come within the camp. 

11. But it shall be, when evening cometh on, he shall wash himself with water; 
and when the sun is down, he shall come into the camp again. 

12. Thou shalt have a place also without the camp, whither thou shalt go forth 
abroad; 

13. And thou shalt have a paddle upon thy weapon; and it shall be when thou 
wilt ease thyself abroad, thou shalt dig therewith, and shalt turn back and cover 
that which cometh from thee; 

14. For the Lord thy God walketh in the midst of the camp, to deliver thee 
and to give up thine enemies before thee; therefore shall thy camp be hol^'; that he 
see no unclean thing in thee, and turn away from thee. 

Austere rulings of the same kind obtained for the enforcement of 
exogamy and the punishment of sexual perversions, incest, bestiality, 
and adultery (Lev. xviii; Exodus xxii-xxiii), and these chapters are the 
literary origins of medical jurisprudence. 

The census of the people by Moses (Num. i, 1-4, xxvi, 1-65) and by 
Joab at the instance of David (I Chronicles, xxi, 3-7) had the usual 
military significance, viz., to ascertain the available man-power of the 
nation for war. 

In the Babylonian Talmud (352-427 A. D.) the presence of an infec- 
tious disease in a community was announced by a warning blast of the 
shofar, but in the case of diphtheria (cschara, eax^po-) this was done 
directly the first case was located, on account of the fatal incidence of 



'< For a readable account of .Mosaic hygiene see (he book by Capt Percival Wood, R. A. .M. C, 
entitled, "Moses, The Founder of Preventive Medicine." London, 1920. 



32 History of Military Medicine 

the disease among infants and children.^^ The Talmudic regulation of 
meat inspection, in connection with the slaughtering of animals, was an 
extension of the Mosaic cult of "clean" (kosher) and "unclean" (trepha). 
It is highly probable, as Sudhotf maintains, that the hygienic supervision 
of meat diet owes its origin to primitive altar practices, i. e,, the determi- 
nation of what rejects of sacrifice were fit to be eaten or otherwise, and 
from this "sacrificial anatomy" (Opferanatomie) the culinary or "butch- 
er's anatomy" of the Middle Ages was also derived. The autopsies 
made in the Hebrew ritual, after the Schdchter had slaughtered the 
animal, were destined, incidentally, to be the source of many observa- 
tions in comparative pathology in the Talmud,^^ indeed, the only recorded 
observations in gross pathology before the time of Benivieni and 
Vesalius. The curious awe and fear of the dead human body, which 
is characteristic of early and primitive peoples everywhere, prevented 
the ancients from doing any scientific work in human anatomy and 
pathology, even as the second commandment interdicted the art of 
sculpture among the Jews. 

The strong prejudice of antiquity against the opening of the human 
body, living or dead, is conveyed to us with sly humor by Celsus. The 
passage is worth quoting in full as showing just how the ancients acquired 
their slender knowledge of human anatomy: 

Nor can anything be more absurd than to suppose the part to be the same in a 
dying man, nay, already dead, as it is in a living person. The abdomen may be 
laid open, it is true, even while the man is breathing (which does not strictly bear on 
the case); but as soon as the knife has separated the praecordia and the diaphragm, 
the man immediately expires; consequently, the praecordia, and all the viscera, 
present the same appearances to the slaughtering physician as those of a dead person, 
not such as they were while he lived; therefore the only object attained by the physi- 
cian is that of murdering a man cruelly; not that he can ever ascertain their nature 
and functions as we have them in life; yet if there be any interesting phenomenon 
to be subjected to the view in the man as yet breathing, practitioners have frequent 
opportunities of meeting them by accidents; for sometimes the gladiator in the 
arena, a soldier in the field, or a traveller intercepted by banditti, is wounded in 
such a manner as to display some of the interior parts, and so, other parts in other 
persons. Thus the prudent physician discovers their structure, relative position, 
arrangement, figure and the like, not by perpetrating murder, but in endeavoring 
to restore health; and learns by compassion what others have discovered by unre- 
lenting cruelty. And for these reasons [I consider it] unnecessary to lacerate even 
the dead, which, though not cruel yet may be disgusting; since most things are found 
very diflferent in dead bodies; even the dressing of wounds themselves may show all 
that can be discovered in the living.-^ 



"J. Preuss: Biblisch-talmudische Medizin. Berlin, 1911, 179. 
" C. D. Spivak: Jewish Encyclopaedia. N. Y., 1904, 412-413. 
" Celsus: De re medica. Proaemiiim. Transl. by A. Lee, London, 1831, 13-14. 



Antiquity, Including Greece 33 

India 

In ancient India medicine was a matter of incantations against 
disease and injury, with a certain amount of herbal therapy. The 
quaUty of this primitive medicine may be sensed from a few of the titles 
of hymns in Professor Whitney's x\tharva Veda, e. g. : 

Against obstruction of urine, with a reed; against leprosy, with a healing herb; 
for welfare and long life of an infant; against worms; a blessing on the kine; to avert 
the ill omen of a twinning animal; for recovery of virility, with a plant; against the 
poison of a poisoned arrow; to heal serious wounds, with an herb; for deliverance 
from unseen pests; for successful pregnancy, with an amulet; against harm from 
improper food; to get rid of cough; to make a certain man impotent; against poison 
of insects and snakes; against intermittent fever, etc. 

As apparent from the above, the treatment of wounds in war is 
mentioned even in the earliest Vedic hymns, the epics (Ramayana), 
and the medical texts. In the medical treatise of Susruta (4th Century, 
B. C.) there is a chapter on "the mode of preserving the life of a king 
whose soldiers are on the march," from which the following paragraphs 
may be quoted: 

A common practice of the enemy under such circumstances is to poison the wells 
on the roadside, the articles of food, the shades of trees (shadowy places) and the 
fuel and forage for cattle; hence it is incumbent on a physician marching with the 
troops, to inspect, examine and purify these before using any of them, in case they 
be poisoned. 

Physicians conversant with the curative virtues of drugs and minerals, and 
priests well versed in the Vedic Mantras, should jointly protect the king from death, 
whether due to idiopathic (Doshaja) or extrinsic causes. 

The death of a king usually leads to a political revolution or to popular disturb- 
ances and brings about a confusion among the vocations of the different orders of 
society. The growth of population markedly suffers through such catastrophes. 

\ physician, fully equipped with a supply of medicine, should live in a camp not 
remote from the royal pavilion, and there the persons wounded by shafts of arrows 
or any other war projectiles, or suffering from the effects of any imbibed poison, 
should resort to him (the physician), conspicuous like a triumphant ensign for his 
fame and professional success. A physician, well versed in his own technical science, 
and commanding a fair knowledge of other allied branches of study as well, is glo^ifi^d 
by his kind and the Brahmanas, and is, like a banner of victory, an ennobling ornament 
to the state. 

The (proper) medicine is that which consists of drugs grown in countries most 
congenial to their growth, collected under the auspices of proper lunar phases and 
asterisms, and compounded in proper measures and proportions, and which is 
pleasing (exhilarating to the mind) and has the property of subduing the deranged 
bodily humours without creating any discomfort to the patient, and which is harmless 
even in an overdose, and is judiciously administered at the opportune moment. 

That person alone is fit to nurse or to attend the bedside of a patient, who is 
cool-headed and pleasant in his demeanour, does not speak ill of anybody, is strong 
and attentive to the requirements of the sick, and strictly and indefatigably follows 
the instructions of the physician.^* 

'' Suahruta Samhita, English txanslation by K. L. Bbisnagratna. Calcutta, 1907, i, 303-307. 



34 History of Military Medicine 

Indian medicine reached its height in the period 327 B. C.-750, A. D. 
the period of Buddhism, which became the creed of India under King 
Asoka (264-227 B. C.)- In 255 B. C. Asoka conquered Kalinga, ac- 
quired dominion over the vast peninsula of Hindustan, renounced war, 
converted his subjects to Buddhism, and ruled for twenty-eight years 
"in light and gentleness." (Wells.) He had innumerable wells dug, 
great shade-trees planted, founded botanic gardens for the cultivation 
of medicinal herbs and, as a rock-inscription records, erected hospitals, 
both for men and animals. Buddhism was more favorable to the arts 
and sciences than the narrow caste prejudices and sterile formalities 
of Brahmanism. In 161 B. C. a dying monarch records that he estab- 
lished hospitals in eighteen different places. The Indian materia medica, 
dietetics, surgery, with the rules for the hygiene and nutrition of infancy 
were the best in this period of antiquity. The surgical instruments, 
over 120 in variety, were well sharpened as to edge and point, and 
every important operation was done except the ligation of arteries. 
The Hindu methods of rhinoplasty and cataract excision were car- 
ried all over Europe by the wandering surgeons of the Middle Ages. 
The Indian mode of splinting fractures with bamboo withes was adopted 
in the British Army as the "patient rattan cane splint." The soporific 
effects of opium, hyoscyamus, and cannabis indica were known. Hypno- 
tism was also employed in surgical operations. Surgery was taught by 
having the students practice swiftness and surety of incision upon 
gourds, melons, lily stalks, etc.; bandaging was practised upon flexible 
models, and venesection was learned by puncturing the veins of large 
green leaves. The Hindus were aware that mosquitoes were somehow 
associated with the transmission of fevers, that when rats fall from the 
rafters, jump about and die, bubonic plague is at hand. Mosquito 
nets were used on the Coromandel Coast. Diabetes was recognized by 
the Indian physicians as Madhumeha (honey-urine), while the syndrome 
of sweetish urine, thirst, foul breath, and debility was recognized later by 
the Arabians. There is abundant evidence that the Indian and Arabian 
physicians were specialists in diabetes and hepatic disorders. 

Hellas 

^Yith the exception of the Spartan State, the Greeks were a brave 
and warlike rather than a strictly military people. Greece was a 
loose federation of independent city states, each with its own peculiar 
religious ideas and form of government. Scattered on the innumerable 
islands and peninsulas and separated (in the hinterland) by abrupt 
mountain walls, these city states were frequently at odds with one 
another, but united on occasion against a common enemy (Confederated 



Antiquity, Including Greece 35 

Hellas). Here they showed unparalleled courage, devotion and patriot- 
ism, but their real contribution was the development of liberty of 
thought in mankind. They were the most intelligent people the world 
has ever seen, never equalled since in their achievement in art and 
science, including the purest strain of medicine we know. 

To understand the Greeks, to know why they are to be placed above 
all other peoples, one may well consider the illuminating appraisal 
furnished by Professor Gilbert Murray for Wells' Outline of History. 
Their outer political history, he points out elsewhere, "like that of all 
other nations, is filled with war and diplomacy, with cruelty and deceit," 
but with almost no experience or material resources, with "clothes like 
Polynesians," with poor tools and no instruments of precision, they 
boldly ventured upon new and untried paths, like some penniless, 
friendless youth of genius who does great things unawares. 

The greatness of Greece comes out only in the art and literature and thought. . . 
Also, an actual achievement in social life — what one calls "Hellenism," i. e., republic- 
anism, simplicity of life, sobriety of thought, almost complete abolition of torture, 
mutilation, etc., and an amazing emancipation of the individual and of the human 
intellect. It is impossible to speak, really, of the "Greek view" of anything. Be- 
cause all the different views are put forward and represented. . . . The characteristic 
is that human thought got free. . . .^' 

It is a remarkable fact that the Greeks of highest genius, including 
every one of their greatest physicians, came from the coastwise colonies 
of Ionia and the outlying islands. While Pericles, Themistocles, Soph- 
ocles and Phidias were seafronting Athenians and .^schylus and 
Thucydides came from Attica, Plato and all the great philosophers 
before him were Ionian islanders, as also the other men of outstanding 
ability.^" This is i eadily understandable when we consider the known 
passion of island, coastwise, seafaring and mountaineering peoples for 
personal, intellectual, political and spiritual liberty. The lonians were, 
as Albutt says, "the young light-hearted masters of the waves, "^^ 
whose modes of thought were 

"Something afar from a pious and puny life, 
Something escaped from the anchorage and driving free." 

Ethnically, the Greeks were made up of a dominating element of 
Nordic strain, the original Dorian invaders of the North who produced 
the splendid warriors and athletic prizemen, and a smaller, darker, 



" Wells: Outline of History. London, 1921, i. 

'"For the lonj: list of Ionian physicians and philosophers, see Allbutt: Greek Medicine in Rome, 
London, 1921, 83-112. 

" Matthew Arnold: The Scholar-Gypsy. 



36 History of Military Medicine 

Mediterranean or Neolithic race, of livelier imagination and, at the 
same time, of more superstitious mentality, "afraid," as Wells says, 
"of the stars and of life." From this fusion there came to be two 
distinct and separate phases of Greek medicine, the one harking back to 
primeval superstitions connected with theurgy, Chaldean astrology, 
the gods of the underworld, Thessalian charms, magic and charlatanry; 
the other forward-looking, keen-sighted, absolutely rational, and, aside 
from an inveterate passion for speculation, scientific in tendency. 

In the island of Crete, some three or four thousand years before 
Christ, there existed a civilization extraordinarily advanced in many 
respects, which illustrates this dualism. The excavations made by 
Sir Arthur Evans suggest a culture as elaborately specialized as those 
of ancient India or Japan. The porcelain figures of the mother goddess, 
with her votaries, clad in gowns of amusingly modern cut, grasp serpents 
with outstretched arms, like Hopi Indians "making medicine." On 
the other hand, the ventilation, sewage piping, bathrooms, stone water- 
closets^^ and other sanitary arrangements of the palace at Knossos 
(the Cretan Labyrinth) are said to excel anything of the kind before the 
nineteenth century. Knossos fell before the northern invaders about 
1400 B. C, and it is now assumed that the leading motive in the Trojan 
War is the usual fable convenue, superimposed upon the main events of 
the general Dorian invasion, about which the Iliad and other ancient 
epics were built up. 

In the Iliad and Odyssey of Homer, the most splendid of all folk 
epics, we have, at one and the same time, the view of epidemic diseases 
as visitations of the wrath of the gods, of the necessity of human sacrifice 
to placate the spirits of the uncremated dead, alongside of a war surgery 
of absolutely rational type. There is only one passage in Homer 
(Odyssey xix, 456-457) in which a charm or incantation is chanted over 
a wound, and its object, to check haemorrhage, was, curiously enough, 
the object of scores of similar folk charms in the Dark and Middle 
Ages. Frolich, who wrote under the spell of Schliemann's excavations 
in the Troad, was ridiculed by some of his contemporaries for making 
an elaborate statistical tabulation of the war- wounds in the Iliad; but, 
if we reflect that no less than 147 wounds are recorded in the great epos, 
his percentages are at least as reliable as what the mathematical laws 
of probability would obtain from 147 throws of dice. Of these 147 
wounds, 106 were spear wounds, with a fatality of 1 out of every 1.25 
cases; 17 sword thrusts, with total mortality; l^ arrow wounds with 
1:2.4 mortality; and 12 wounds from stone-slings with 1:1.5 mortality. 



'2 For an account of which see the article by CapU T. H. M. Clarke, R. A. M. C, in Brit. Med. 
Jour., Lond., 1903, ii, 597-5Q9. 



Antiquity, Including Greece 37 

The total mortality' was 114 or 77.6 per cent, and of these fatahties 31 
were head wounds, 13 injuries of the neck, 67 chest wounds, 10 and 
11 wounds of the upper and lower extremities respectively. This is 
about what we should expect from wounds with armes blanches, with 
no operative treatment. As shown by Frolich's tabulation, the relative 
percentile frequency of the Homeric wounds in different localities as 
compared with the incidence of his own time (1879) was: Head 21 per 
cent: 7 per cent; neck 11:2; chest 54 : 21; upper extremities 7: 26; lower 
extremities 7:44.^^ 

The old Ionian word for physician (tTjrpoj), as employed by Homer, 
meant originally "an extractor of arrows." The war surgerj' of the 
Iliad was what the mediaeval peoples called wound surgery — i. e., 
expectant treatment of wounds — and was carried out by a number of 
regular surgeons (Iliad xiii, 213; xvi, 28), and by certain warrior chief- 
tains (Machaon, Podalirius, Achilles, Patroclus, Agenor) who were 
adept in wound treatment. The battle formation described in the 
Iliad (iv, 297) was of the phalanx order, with infantry in the rear, horse- 
men and charioteers in the front line, and "cowards in the middle." 
Battles began with individual skirmishing and trial combats, the 
horse and chariots going to the rear before an infantry assault, but taking 
the front line in a general advance. After the fashion of primitives, 
a wounded hero was dragged or borne out of danger by his comrades, 
sometimes placed under a tree to die (v, 693), but was usually taken to 
a chariot (xiv, 429), which bore him to the kiisia^* or hut-like barracks 
near the black ships (xi, 517; 834). Here he was given a stimulating 
draught of wine, the "wound-drink" of the Middle Ages (xiv, 5), his 
clothing was loosened in the region of the wound (iv, 215), which was 
then washed with warm water (xi, 829; xiv, 6-7) and, if necessary, further 
examined (iv, 190). An imbedded spear or arrow-point was either 
withdrawn (v, 112; 693) or cut out by widening the wound (xi, 844). 
The wound was then treated with various herbs relieving pain (iv, 191, 
218, etc.) or with the juice of some bitter root (xi, 846), and finally 
bound up with a woolen bandage (xii, 599), In one instance, Machaon 
sucks out the blood after extracting an arrow from Menelaus (iv, 218),^^ 
a practice which was to survive even down to the days of the "wound- 
suckers" who followed duellists in the eighteenth century. 

A fair specimen of this wound surgery is the treatment of the arrow 
wound of Eurypylus by Patroclus (xi, 834-847) : 



" Frolich: Die Milit4rmedicin Homer's. Stuttgart. 1879, 58-60. 

»* Usually translated "tents," but, as Frolich shows, these "tents" are always described as "well- 
built" and were in fact, constructed of hewn lumber, with thatched roofs. A closer translation would 
probably be "huts." 

" Frolich: op. eii., pastim. 



38 History of Military Medicine 

He said, and having laid hold of the shepherd of the people under his breast 
bore him to the tent, and his attendant, when he saw him, spread under him bulls' 
hides. There Patroclus, laying him at length, cut out with a knife the bitter sharp 
arrow from his thigh, and washed the black blood from it with warm water. Then 
he applied a bitter pain-assuaging root, rubbing it in his hands, which checked all 
his pangs; the wound, indeed, was dried up and the bleeding ceased. 

Legendary as all this is, it was about the standard procedure 
followed in ordinary wound treatment up to the changes necessitated 
by the introduction of firearms in the Middle Ages. 

The epidemic visited upon the Grecian host by the wrath of Apollo, 
attacking both mules and men, was probably dysentery, which has been 
endemic in the Mediterranean basin for centuries, was described by 
Hippocrates, and in 1915 "destroyed mules and many thousands of our 
men in Gallipoli, just across the Hellespont from Troy" (Edgeworth).^^ 

The next most important sources for the military medicine of the 
Greeks are the writings of Hippocrates and Herodotus, and of the dim 
and distant background which these great names imply, Sir Clifford 
Allbutt says in his "Greek Medicine in Rome:" 

It is no barren fancy to associate the Father of Medicine in our imagination with 
the Father of History. Both inherited the luminous Ionian mind; and the author of 
Airs, Waters and Places, cradled on the same enticing seas, had likewise travelled 
widely and observed shrewdly; both saw common things under the species of a 
large humanity. Indeed, the Hippocratic scriptures themselves thus testify to 
some great school and tradition of medicine, which, sown and watered in a forgotten 
and unrecorded past, bore ultimately its golden fruit in the great master himself, 
and onwards in Aristotle and the scientific schools of Alexandria. '^ 

Over five hundred years intervened between the time of Homer and 
the advent of Hippocrates, whose authentic writings are, in effect, a 
summation of what was accomplished by Greek medicine in this long 
period of "silence in the records." Open the true Hippocratic canon 
almost anywhere and you will light upon clean-cut reasoning like this, 
sentences which we, 2400 years later, are pleased to regard as "modern" 
in tendency: 

PHYSICIANS AS GOOD AND BAD ACTORS 

Medicine is of all arts the most noble; but, owing to the ignorance of those who 
practice it and of those who inconsiderately form a judgment of them, it is at present 
far behind all the other arts. Their mistake appears to me to arise principally 
from this that in the cities there is no punishment connected with the practice of 
medicine (and with it alone) except disgrace, and that does not hurt those who aie 
familiar with it. Such persons are like the mimes or dummy figures int oduced in 
tragedies, for as they have the shape and dress and personal appearance of an actor, 
but are not actors, so also physicians are many in title but few in reality. — The Law. 



'« F. II. Edgeworth: Bristol Med.-Chir. Jour., 1916, xxxiv, 115. 
" AJlbutt: Greek Medicine in Rome. London, 1921, 180. 



Antiquity, Including Greece 39 

DIVINE ORIGIN OF EPILEPSY 

And they who first referred this disease to the gods appear to me to have been 
just such persons as the conjurors, purificators, mountebanks and charlatans now 
are, who give themselves out for being excessively religious and as knowing more 
than other people. Such persons, then, using the divinity as a pretext and screen 
of their own inability to render any assistance, have given out that the disease is 
sacred, adding suitable reasons for this opinion. . . . But this disease seems to 
me no more divine than others; but it has its nature such as other diseases have, and 
a cause whence it originates, and its nature and cause are divine only just as much 
as all others are, and it is curable no less than the others, unless when, from length 
of time, it is confirmed and has become stronger than the remedies applied. Its 
origin is hereditary, like that of other diseases. — On the Sacred Disease. 

FIGHTIXG QU.\LITIES OF FREE .\ND ENSLAVED PEOPLES 

Monarchy prevails in the greater part of Asia, and where men are not their own 
masters nor independent, but are the slaves of others, it is not a matter of con- 
sideration with them how they may acquire military discipline, but how they may 
dodge the responsibilities of valor; for the dangers are not equally shared, since they 
must serve as soldiers, perhaps endure fatigue, and die for their masters, f;^ from 
their wives, children and friends; and whatever noble and manly actions they may 
perform lead only to the aggrandizement of their masters, whilst the fruits which 
they reap are dangers and death. . . . Thus, then, if any one be naturally warlike 
and courageous, his disposition will be changed by the institutions. As a strong 
proof of all this, such Greeks or Asiatic barbarians as are not under a despotic form 
of government, but are independent and enjoy the fruits of their own labors, are of 
all others the most warlike; for these brave danger on their own account, bear the 
prizes of their own valor, and, in like manner, endure the punishment of their own 
cowardice. — Airs, Waters and Places, 16. 

SANITARY SURVEY OF A LOCALITY 

When one comes into a city to which he is a stranger, he ought to consider its 
situation, how it lies as to the winds and the rising of the sun . . . and concerning 
the waters which the inhabitants use, whether they be marshy and soft, or hard, 
and running from elevated and rocky sites, and then if salty and unfit for cooking; 
and the ground, whether it be naked and deficient in water, or wooded and wel] 
watered, and whether it lies in a hollow, confined situation, or is elevated and cold; 
and the way in which the inhabitants live, and what are their pursuits; whether they 
are fond of eating and drinking to excess, and given to indolence, or are fond of exer- 
cise and labor and not given to gluttony and drunkenness. From these things he 
must proceed to investigate everything else. For if one knows all these things 
well, or at least the greater part of them, he cannot miss knowing when he comes 
into a strange city, either the diseases peculiar to the place or the particular nature 
of common diseases. . . . And, in particular, as the season and the year advances, 
he can tell what epidemic diseases will attack the city, either in summer or winter. — 
Airs, Waters and Places, 1. 

THE PRACTICE OF MEDICINE 

The physician must have two special objects in view with regard to diseases 
viz., to do good or to do no harm. The art consists in three things — the disease, 
the patient and the physician. The physician is the servant of the art and the pa- 
tient must combat the disease along with the physician. — Epidemic Diseases. I, 5. 



40 History of Military Medicine 

SIGNS OF APPROACHING DEATH 

The gravest are the following; a sharp nose, hollow eyes, collapsed temples, the 
ears cold, contracted, with lobes turned out; the skin about the forehead rough, 
distended and parched; the color of the whole face green, black, livid, or lead-colored. 
... It is a mortal symptom, also, when the lips are relaxed, pendent, cold and 
blanched. . . . When in acute fevers, pneumonia, phrenitis or headache, the hands 
are waved before the face, hunting through empty space, as of gathering bits of 
straw, picking the nap from the coverlid or tearing chaff from the wall — all such 
symptoms are bad and deadly. — Prognosis, 2. 

RESPIRATION IN DISEASE 

Respiration, when frequent, indicates pain or inflammation in the parts above the 
diaphragm; a large respiration, performed at wide intervals, announces delirium; 
but a cold respiration at nose or mouth is a very fatal symptom. Free respiration 
is to be looked upon as contributing much to the safety of the patient in all acute 
diseases. — Prognosis, 5. 

CHEYNE STOKES RESPIRATION IN A F.\TAL CASE 

The breathing throughout, like that of a person recollecting himself, was rare 
and large. — Epidemic Diseases, I, 13. 

CLINICAL APHORISMS 

Use the lightest diet at the height of an acute disease. 
Slop diet is suitable in all febrile diseases, particularly in children. 
Labored sleep in any disease is a bad sign. 
Sleep following upon delirium is a good sign. 
Spontaneous lassitude indicates disease. 

Insensibility to great local pain shows that the mind is affected. 
Liquid diet is better for emaciation than solid. 
Never work when hungry. 

Overeating brings on illness, as shown by the treatment. 

Old persons have fewer diseases than the young, but chronic diseases never 
leave them. 

Very fat persons are apt to die earlier than the slender. 

Sandy sediment in the urine means vesical calculus. 

Blood or pus in the urine points to erosion of the bladder or kidneys. 

Spasm supervening on a wound is fatal. 

Epista.xis in amenorrhoea is good. 

Induration of the liver in jaundice is bad. 

Spinal deformity often coexists with cough and tubercle of the lungs. 

Here we have something utterly different from the chaotic rum- 
ble bumble of Mesopotamian and Egyptian medicine and something 
not to be explained by the three thousand years intervening, namely, 
the free play of a great mind. The Hippocratic descriptions of phthisis, 
epidemic mumps, epilepsy, the malarial fevers and puerperal convulsions 
could go without change mto any text-book and nothing quite so close 
to fact was recorded again before the Renaissance, 2,000 years later. 
Hippocratic surgery is mainly orthopedics and wound surgery. The 
Hippocratic treatises on fractures, dislocations, head injuries and ulcers 



Antiquity, Including Greece 41 

are among the greatest surgical writings of all time. This surgery 
was, in the main, aseptic, inculcating the use of water as warm as the 
surgeon's hands could bear, cleansing of the operator's hands, trimming 
of the nails, dry wound treatment (with avoidance of greasy dressings), 
rest and immobilization, with a clear notion of healing by first and 
second intention. The directions for trephining and for setting frac- 
tures and dislocations are minute and have been followed for centuries. 
That the surgery of Hippocrates was mainly derived from and adapted 
to military conditions is indicated by his own statement in "The 
Physician;" "Fights between citizens and their enemies are rare, but 
frequent and almost daily between mercenary soldiers; he who would 
become a surgeon, therefore, should join an army and follow it." War 
was the only school for surgery at this time, for the Athenians had 
already established their great principle that the bearing of arms by 
civilians is not civilization (Thucydides). "They strove to make gentle 
the life of the world." ^yith the Spartans, continuous military duty 
was obligatory between the ages of twenty and sixty, while in the 
other Greek states, young men were trained for two or three years and 
released from duty until the hour of need. The Spartans "lived the life 
of a regiment. Private homes resembled the 'married quarters' of a 
modern army; the unmarried men lived entirely in barracks. Military 
exercises were only interrupted by actual service in the field, and the 
whole life of a man of military age was devoted to them."^^ In such a 
"nation in arms" as Sparta there was some regular medical service, as 
suggested by the law of Lycurgus that the army surgeons retire to the 
rear of the right wing during an engagement. 

According to Xenophon,^^ the surgeons in the Spartan army shared 
the same tents with the nobles, the soothsaj-ers and the flute-players. 
In battle, the wounded were rescued by Helots. 

The History of Herodotus (484-424 B. C.) is at once an account of 
his many travels and a general history of Greece, up through the glorious 
period when the tiny states of Athens and Sparta, relying upon courage 
and enterprise alone, defeated the gigantic Persian power and saved 
Europe for a finer civilization. Herodotus and Xenophon are our 
principal sources for the medical arrangements of the Persian Army, 
the earliest military organization of magnitude with which recorded 
history deals. This great army, strong in cavalry, originally made up 
of Persians alone, was, at the time of the expedition against Greece, 
augmented by a huge levy of all nationalities. The phj'sicians of the 
Persian Army and fleet were mercenaries, usually Egyptians or Greeks. 
One of the latter, Democedes of Croton (520 B. C), a high-salaried health 

'* Capl. C. F. Atkinson: Encyclop. Hritannica, 11 ed., Cambridge, 1910, ii, 593. 
"Xenophon: Lacedaemon. Respubl. iii, 7. Cited by Withington. 



42 History of Military Medicine 

officer, being retained at the court of Darius as a captive, actually led 
an advance guard of Persian spies into Greece in order to get back to 
his home town (Herodotus, iii, 131-137). Herodotus, a teller of tales, 
has little to say of organization, but he has many interesting anecdotes, 
e. g., of the mortality in the Persian army from gluttony and change of 
water-supply (viii, 117), of their sufferings from epidemic diseases, of a 
traumatic haemoptysis following a fall from a horse (viii, 88), of various 
wounds, of the treatment of wounds with dressings of myrrh and flaxen 
bandages (vii, 181), and of the deaths of Cambyses and Miltiades from 
traumatic septicaemia or gangrene (iii, 64-66; vi, 134-136). 

Xenophon (444-357), a pupil of Socrates (who had saved his life at 
the battle of Delium), was one of the generals commissioned by the 
younger Cyrus to raise an army of 10,000 Greek mercenaries ("a march- 
ing city state") for his expedition against Artaxerxes. After the defeat 
and death of Cyrus at Cunaxa (401), Xenophon conducted the retreat 
of the Ten Thousand Greeks from Babylonia back to their own country. 
The Anabasis is the story of this expedition and retreat (415-400 B. C). 
The army consisted of heavy infantrymen (Jiopliies) witli bronze shields 
and helmets, purple tunics, corselets of bone, armed with swords and 
spears, and light infantrymen (peltasfes) armed with javelins and 
wooden shields. Their pay was about $5.50 monthly, their commissariat 
meal, mares' milk, and wine, bought of the sutler, with occasional 
slaughtering and barbecues of animals, when supplies gave out, or in 
connection with sacrificial rites. 

In the whole narrative of the retreat there is only one mention of 
medical service (iii, 4), although Xenophon himself was sometimes 
forward with medical aid and advice (v, 8) : 

Marching thus for the rest of the day, some on the road over the hills, others 
advancing abreast of them over along the mountains, they came to the villages, and 
eight surgeons were commandeered, for there were many wounded. Here they 
remained three days, both on account of the wounded and because they had found, 
at the same time, abundant supplies, viz., wheat-flour, wine and barley, which had 
been stored up for horses. These supplies had been collected for the then satrap 
of the country. But on the fourth day, they went down unto the plain. When, 
however, Tissaphernes overtook them with his command, necessity taught them to 
encamp at the nearest village and not to fight while marching; for there were many 
unfit for action, viz., the wounded, those carrying the wounded and those who bore 
the arms of such carriers. 

In the action preceding this halt, we are told that "the Greeks of 
their own motion, mutilated the dead, that it might be frightful for 
the enemy to see" (iii, 4). To lighten the march, the arms were some- 
times carried in the wagons, the wounded usually on the backs of 
comrades, and one bearer was publicly scourged, by order of Xenophon, 



Antiquity, Ixcluding Greece 43 

for trying to bury a wounded man to get rid of his burden (v, 8). The 
troops suffered much from cold and frostbite in Armenia, many freezing 
to death, others laboring under snow-blindness, and Xenophon was 
extremely solicitous that no one should sink to sleep in the snow and 
kept his troops in constant motion (iv, 4, 5). Arrow wounds are 
mentioned, experiences with poisonous honey and headache from date- 
wine, and it is of record that potable water was boiled by the Persians 
for Cyrus in silver kettles (Herodotus, I, 188). 

Upon returning to Athens, Xenophon found that Socrates had been 
put to death and his own knightly order in disrepute in the city, where- 
upon, with the remainder of the Ten Thousand, he joined the forces of 
Agesilaus, king of Sparta, and after the fashion of disaffected Hellenes, 
actually fought against his own native city at Coronea (394 B. C). 
During the rest of his exile he wrote the Cyropaedia, or life of Cyrus, 
a purposeful glorification of the Persian Empire and army, in aid of 
his dream of a Confederated Hellas, a project for which Herodotus wrote 
his history, Isocrates his orations, and Aristotle his Politics. The 
liberal constitution and government ascribed to an Oriental despotism 
by Xenophon are purely mythical, and borrowed from the institutions 
of the Greek city states. In the Cyropaedia (i, v, 15-19) Cyrus says to 
Cambyses, his father, that even as states that wished to be healthy 
elected a board of health, so he took with him men eminent in the 
medical profession, as did other generals. In the discussion that follows, 
one senses the genial superiority of the workings of the Greek mind: 

"Yes, my son," said his father in reply to this, "but just as there are menders 
of torn garments, so also these physicians whom you mention heal us when we fall 
sick. But your responsibility for health will be a larger one than that; you must 
see to it that your army does not get sick at all." 

"And pray what course shall I take, father," said he, "that I may be able to 
accomplish that.'" 

"In the first place, if you are going to stay for some time in the same neighbor- 
hood, you must not neglect to find a sanitary location for your camp; and with 
proper attention you cannot fail in this. For people are continually talking about 
unhealthful localities and localities that are healthful; and you may find clear wit- 
nesses to either in the physique and complexion of the inhabitants; and in the second 
place, it is not enough to have regard to the localities only, but tell me what means 
j-ou adopt to keep well yourself." 

"In the first place, bj' Zeus," said Cyrus, "I try never to eat too much, for 
that is oppressive; and in the second place, I work off by exercise what I have eaten, 
for by so doing health seems more likely to endure and strength to accrue." 

"That, then, my son," said he, "is the way in which you must take care of the 
rest also." 

"Yes, father," said he; "but will the soldiers find leisure for taliing physical 
exercise.' ' 

"Nay, by Zeus," said his father, "they not only can, but they actually must. 
For if sn army is to do its dut\% it is absolutely necessary that it never cease to 



44 History of Military Medicine 

contrive both evil for the enemy and good for itself. What a burden it is to support 
even one idle man! It is more burdensome still to support a whole household in 
idleness; but the worst burden of all is to support an army in idleness. For not 
only are the mouths in an army very numerous but the supplies they start with are 
exceedingly limited, and they use up most extravagantly whatever they get, so that 
an army must never be left idle." 

"Methinks, you mean, father," said he, "that just as a lazy farmer is of no 
account, so also a lazy general is of no account at all." 

"But at any rate, as regards the energetic general," said his father, "I can 
vouch for it that, unless some god do cross him, he will keep his soldiers abundantly 
supplied with provisions and at the same time in the best physical condition." 

In the same work (iii, ii, 12), we are told how Cyrus detailed physi- 
cians to treat wounded prisoners: 

At this juncture they brought to Cyrus the prisoners in chains and also some 
that had been wounded. And when he saw them he at once ordered that the fetters 
be taken off, and he sent for surgeons and bade them attend to the wounded men. 
And then he told the Chaldeans that he had come with no wish to destroy them and 
with no desire to make war, but because he wished to make peace between the 
Armenians and the Chaldeans. 

The army of Philip of Macedon, with its famous phalanx, had physi- 
cians, one of whom, Critobulus, extracted an arrow from Philip's eye 
at the siege of Methone. On the expedition of Alexander the Great 
(336-323 B. C), physicians were again present, notably Philip, Critobu- 
lus and Glaucus. Philip, Alexander's body physician, who was once 
accused of trying to poison him, cut out an arrow from his shoulder at 
the siege of Gaza. Glaucus was crucified for failing to heal Haephaes- 
tion. There is plenty of evidence of the presence of physicians at battles 
in Greek history. An inscription of 450 B. C. at Dali in Cyprus records 
a decree of the Demos that the physician Onasilos and his pupils be 
rewarded for attending the wounded in the Idalian expedition against 
the Persians. That the physician Ctesias healed the wound of Artaxerxes 
at Cunaxa is recorded in the Anabasis (i, 8). Epaminondas, creator 
of the Theban phalanx and of the swift oblique movements adopted 
by Frederick the Great, was mortally wounded at Mantinea (362 B. C), 
his death resulting from the withdrawal of a spear from the wound by 
his physician. Finally, at the defeat of the Spartans at Sellasia (222 
B. C), the Greek's last stand for freedom, every house opened its doors 
and all Lacsedemonians united in refreshing the soldiers and in binding 
up their wounds, a trait more characteristic of republican Rome than 
of Greece.^" 

Much was done for the health and stamina of soldiery by the splendid 
system of physical training and cult-cleanliness of the Greeks, their 
gymnastics and bathing habits, which have become the ideal of our own 

" E. T. Withington: Medical History. London, 1894, 74. 



Antiquity, Including Greece 45 

time, both in military and civil hygiene. A Greek vase in the Louvre 
shows a youth preparing to wash his feet, with the inscription epxerat, 
"he makes himself ready for marching."" That shower baths of recent 
type were common is also evident from these antique vases. '^^ 

Of the total achievement of the Greeks in personal and public hygiene, 
in the light of recent researches, of what they did for physical training 
and military morale, Sudhoff has WTitten with force and precision :^^ 

Viewed in the light of hygiene alone, classical antiquity, Greece and Rome, 
represent a cultural pinnacle of almost incomparable height. 

The Greeks, a master people (with a substratum of slaves), for the first time in 
history, and in a scope and degree never again approached, undertook universal 
training of boys (in some phratries, of girls, also), with a view to the harmonious 
development of all the physical faculties and to the attainment of the greatest 
measure of strength, dexterity and self-confidence, of physical perfection and beauty. 
The system was founded upon daily exercise from earliest youth to ripe manhood, 
under the supervision of experienced and practised leaders, who not only strove to 
make it viable and successful, but were capable of intelligent specialization, exacting 
from each physical entity the highest possible accomplishment, with constant refer- 
ence to general vigor. The teacher of gymnastics became the professional "gym- 
nast," who strove to comprehend the normal functions of the body, vying with the 
medical fraternity, who again studied the value of gymnastics for a healthy physique 
and took from its storehouse of anatomic-physiologic knowledge the plumb line for 
estimating the possibilities of each individual. With the aid of general dietetics, 
the physicians deduced the norms for the application of gymnastics to the prevention 
of bodily ills and as an auxiliary in the treatment of general or organic disorders. 
Under this beneficent rivalry between professional gymnast and physician, gym- 
nastics itself became a scientific system of physical exercise and invigoration, of 
hygiene of movement and occupation, such as we today, with the aid of mod'^rn 
technique and instrumental precision, are intent upon creating anew. 

With this central endeavor of Hellenism (physical invigoration by daily gym- 
nastic exercise), the rest of personal hygiene was in great measure associated, viz., 
care of the skin by washing and bathing, by swimming and massage; physical clean- 
liness, including care of the hair and clothing; as well as regulation of diet, rest and 
sleep, and of the sexual life. The regulation of the latter function in the gymnastic 
exercises of girls was divorced from prudery and had a definite eugenic aim: vigorous 
offspring. 

The public officers of Greece were engrossed with other questions of hygienic 
importance. Town planning, arrangement of streets, sunning of houses, sewage 
disposal and water supply were carefully considered and purposefully regulated, 
especially in the culminating cultural period of the Age of Tyrants. The Romans, 
among whom solicitude for the purity of grain and potable water was recognized 
almost as a religious and state duty, with their eminent talent for solving great 
problems, contributed much to public hygiene. In the days of their world empire, 
water supply, drainage, road-building, town-planning, food-control, heating, and 
baths were regulated with a thoroughness which evokes our respectful admiration 



"Sudhoff; .Vus dem antiken Badewesen. Berl., 1910, 17-1£ 

•'Sudhoff: op. cii., 59-62 (illustrations). 

" Sudhoff: Ann. Med. History, N. Y., 1917-18, i. 112-113 



46 History of Military Medicine 

even today. In the cult of Vesta and Juturna, the Roman early evinced an inherent 
sense of the fundamental necessity for purity of food, which can proudly take its 
place beside the justly extolled cult of food-hygiene of the Orient. . . . For Graeco- 
Roman antiquity, we must again repeat that, although hygienic requirements were 
partly based on cult-hygiene, these peoples soon outgrew this purposeless infancy 
and set themselves conscious hygienic goals, devoted themselves to their attainment 
in a large genial manner, and accomplished results which, in addition to constituting 
a scientific supervision of the life of the individual, will forever merit admiration as 
the first attempt (conceived and executed with genius) at personal and public hygiene 
with definite aims: indirect prophylaxis by increasing the vigor and resistance of 
two whole nations. 



CHAPTER III 
Rome 

(Republic and Empire) 

In a delightful little book, issued by the London Society for Pro- 
moting Christian Knowledge,^ Flinders Petrie cautions historical stu- 
dents against our common human tendency to condemn or cry down 
a given thing because Nature made it what it is and not something 
else: 

When we try to estimate the condition of historic periods we must not lay too 
much stress on unaccustomed features. The Egyptian kings of the XVIIIth dynasty 
have been absurdly compared to Mtesa, because they maltreated their enemies. 
Rather we should class them above Louis XlVth, who infamously tortured his most 
faithful subjects if they differed from him in religion. We must avoid trusting our 
judgment too exclusively either on moral or on artistic grounds — both have their 
place in judging of a civilisation. We must not refuse our admiration for the "best 
and greatest" of Emperors, Trajan, because his life was such that he would be sent 
to penal servitude in these days. . . . Similarly, on the other hand, we must not 
depreciate the moral grandeur of Isaiah or Amos because the sculpture of that age is 
trivial and its pottery ugly. Nor must we depreciate Greek art and philosophy 
because their politics were shortsighted and amenable to Persian gold. Each civilisa- 
tion has to be adapted to its own conditions, and by its success in those conditions, 
and the benefits it has bequeathed to mankind, it must be judged by posterity. 

In considering the Romans, an essentially military nation, one 
should endeavor to see this great people also "with the equal eye of 
Nature." The systematic depreciation of Caesar, Augustus and the 
better sort of emperors, by Wells (as socialistic propaganda), may be 
taken cum grano salis, like the laborious whitewashing of Henry VIII 
by Froude (for theological reasons), or of Tiberius Caesar by Ferrero 
(for reasons known only to himself). There are two great social forces 
which have been in continual conflict since the Roman period, one defined 
by Roosevelt as "centrifugal," as seeking individual freedom and 
independence at the expense of stable, centralized government; the other 
"centripetal," seeking a rigid, stable social order at the expense of 



' W. M. Flinders Petrie: Some Sources of Human History. London, 1919, 22. 

47 



48 History of Military Medicine 

personal liberty.^ The logical term and end of the one is anarchy; 
of the other, tyranny. In adjusting the merits of either, the exquisite 
judgment of Theodor Mommsen remains unassailable for equity and 
fairness, even though his argument now reads like a veiled defense of 
Prussian policy: 

It is only a pitiful narrow-mindedness that will object to the Athenian that he did 
not know how to mould his state like the Fabii and the Valerii, or to the Roman that 
he did not learn to carve like Phidias and to write like Aristophanes. It was in fact 
the most peculiar and the best feature in the character of the Greek people that 
rendered it impossible for them to advance from national to political unity without at 
the same time exchanging their polity for despotism. The ideal world of beauty 
was all in all to the Greeks, and compensated them to some extent for what they 
wanted in reality. Wherever in Hellas a tendency towards national union appeared, 
it was based not on elements directly political, but on games and art: the contests at 
Olympia, the poems of Homer, the tragedies of Euripides, were the only bonds that 
held Hellas together. Resolutely, on the other hand, the Italian surrendered all 
arbitrary aspiration toward freedom, and learned to obey his father that he 
might know how to obey the state. Amidst this subjection individual development 
might be marred, and the germs of fairest promise in man might be arrested in the 
bud; the Italian gained in their stead a feeling of fatherland and of patriotism such as 
the Greek never knew, and alone among all the civilized nations of antiquity succeeded 
in working out national unity in connection with a constitution based on self-govern- 
ment — a national unity, which at last placed in his hands the mastery not only over 
the divided Hellenic stock, but over the whole known world.' 

The Romans, compounded of an ascendant Northern strain (Umbrian 
and Sabine), an Oriental strain (Etruscan), an autochthonous, neolithic 
strain (Ligurian), and (in Southern Italy) of an independent group of 
Hellenic colonials (Magna Graecia), were more diverse and stranger 
in their ethnic plies than the Greeks; but the "close-fisted Umbrian," 
the " sombre Puritanical Sabine " and the " obese Etruscan " were all of a 
piece in warlike disposition, in hard and exclusive caste feeling, in dog- 
ged, obstinate perseverance, in rustic austerity of demeanor and morals 
and "by their fusion Rome was created" (Allbutt)* The dominating 
Latin stock was thus rustic, tight fisted, hard bargaining, like all tillers 



' "Why do great eu'tificial empires, whose citizens are knit by a common bond of speech and culture 
much more than by a bond of blood, show periods of extraordinary growth, and again of sudden or 
lingering decay? In some cases we can answer readily enough ; in other cases we cannot as yet even 
guess what the proi)er answer should be. If in any such case the centrifugal forces overcome the 
centripetal, the nation will of course fly to pieces." Theodore Roosevelt: Biological Analogies in 
History, New York, Oxford Univ. Press, 1910, 23. 

•Mommsen: History of Rome, N. Y., 1870, I, 55. 

•AUbutt (Greek Medicine in Rome, 14) notes the shrewd differentiation of these ethnic strains by 
the poet Catullus (88-58 B.C.): "Si urbanus esses aut Sabinus aut Tiburs 
Aut parcus Umber aut obesus Etruscus 

Aut Lanuvinus ater atque dentatus, etc. (XXXIX, 10-12) and 
elsewhere the "tetrica et tristis Sabinorum disciplina." 



Rome 49 

of the soiP, "more superstitious than reHgious," yet canny rather than 
narrow-minded, with httle or no artistic feehng, and no medicine except 
folk- or domestic medicine. The slow climb to the highly artificial 
civilization of the Empire (with its wonderfully organized army and 
medical corps as the backbone of the state) was a long process of trial 
and error, "always more remarkable," as Mommsen says, "for tenacity, 
cunning and consistency than for grandeur of conception or power of 
rapid organization." Time and again the Romans failed in battle, as 
in the egregious blunders of the Punic Wars, but in the end the very 
name "Roman" came to imply rugged fortitude and contempt for dis- 
aster, invincible morale, dogged tenacity of purpose and unbeatable 
persistency of effort. "The Hellenes," says Mommsen, "sacrificed 
the whole to its individual elements, the nation to the township, and 
the township to the citizen." The Romans, on the other hand, "bade 
the son to reverence the father, the citizen to reverence the ruler, and 
all to reverence the gods; required nothing and honored nothing but the 
useful action; compelled every citizen to fill up every moment of his 
brief life with incessant work; condemned every citizen who wished to 
be different from his fellows; regarded the state as all in all and a desire 
for the state's extension as the only aspiration not liable to censure" 
(II, 48). The Roman gods, were not, as with the Greeks, 

"The intelligible forms of ancient poets, 
The fair humanities of old religion,"' 

but metaphysical abstractions applied to every object or event in life 
(plowing, child-birth, scabies, malarial fever, etc.). The Roman con- 
ception of religion (religio), was, as with the Hebrews, "that which 
binds." In Allbutt's view, "Rome starved individual religion by identi- 
fying it with the state and by using it as a buttress to the imperial 
power. "^ 

In the citizen army of republican Rome there were no medical 
arrangements for the care of the sick and wounded beyond the ordinary 
wound-dressing we have seen in the Iliad. Early Rome was mainly 
an agricultural community, with no provisions for medicine, beyond 
such skill in domestic and veterinary medicine as every citizen, as 
house-father, was expected to have and to practise. In the days of the 
Empire, Greek medicine had become firmly established in Rome, and 
the imperial armies acquired a well-organized medical establishment, 
the first and the best in antiquity. 



' Some of the bravest and ablest of the earlier RomaQ commanders, e.g., Marcus Furius Camillus, 
Marcus Curius Dentatus and L. Quintius Cincinnatus, went straight from the plow to the field of 
battle. 

'Schiller: Wallenstein (Coleridge's translation). 

'Sir T. C. AUbutt: Greek -Medicine in Rome, London, 1921, CI. 



50 History of Military Medicine 

Organization of the Roman Army under the Republic^ 

The Roman Army began with the foundation of Rome (753 B.C.) and for cen- 
turies was made up of organized militia, i.e., of levies of citizens. The army of 
Romulus consisted of 300 light cavalrymen (celeres) and 3,000 infantry (milites), 
to which each of the three tribes contributed a third, commanded by their own 
tribunes. These soldiers provided their own arms and armour, served without pay 
as a patriotic privilege, and were drawn mainly from the better classes of society. 
Under the king Servius Tullius (578-534 B.C.), the so-called Servian constitution 
went into effect, reorganizing the whole fabric of Roman society along military lines. 
Every householder, even the manumitted slave who held property, was made liable 
to military service between the ages of 17 and 60, with the sensible regulation that 
those between 17 and 46 served in the field, those between 47 and 60 within the walls 
of the city. The centuriae of cavalry were increased six-fold (1,800); each legion of 
infantry now consisted of 4,1^00 men, of whom 3,000 were the original heavy infantry 
(hoplites) of Romulus, and 1,200 light infantry (reliies), who, in later times, were 
usually commandeered to evacuate the wounded after battles. The selection of this 
army was apportioned among four districts of the state, according to the findings 
of the census, which was instituted by Servius for the sole purpose of ascertaining the 
military man-power of Rome. 

During the early period when the Romans, beleaguered by enemies, had to fight 
for their very existence, the battle organization was the old Grecian phalanx, a solid 
front of 500 men, six files deep. The troops in the rear files were protected by man- 
sized shields (clypei), which proved very useful in covering or bearing wounded 
comrades. As the Roman nation advanced from a policy of self-defence and self- 
determination to the necessary assimilation of the whole peninsula of Italy, an army 
of conquest was developed, the main advantages of which were a system of pay and 
long service, so that even the poorer classes who owned no property {capite censi) 
were privileged to serve. These changes were instituted about the time of the siege 
of Veii (896 B.C.) and are attributed to Marcus Furius Camillus. Camillus sub- 
stituted for the old phalanx formation a three-line arrangement by maniples, a 
flexible chess-board formation in open order (3 x 10), which threw the responsibilities 
of initiative upon each isolated unit and each individual man. In this arrangement, 
the front row {hastati) bore the brunt of battle, the second row (principes) passing 
through the intervals and taking the front line if the hastati gave out, while the third 
row (triarii) remained kneeling behind their shields, closing up the intervals and 
participating in a general assault only when the whole line wavered. It was through 
this battle formation that Roman valor won its distinctive laurels in the days of the 
Republic. The main defect of the Roman Army in this early period was that ap- 
pointments to commands were temporary and political. As every Roman citizen had 
military training, the two consuls became ex officio commanders-in-chief of the army, 
with the result that no individual military policy could be permanent. Commands 
as well as commanders were influenced by the programs of political parties and the 
vacillation, hesitation, and dread of responsibility, which go along with temporary 
or precarious tenure of office, were everywhere apparent.^ 



"The best and most thoroughgoing account of the administration of the Roman Army, including 
its medical arrangements under the Empire, is that of Joachim Marquardt in Marquardt & Mommsen: 
Handbuch der romischen Alterthiimer, 2. Aufl. Leipzig, 1884, v (Romische Staatsverwaltung, II, 
pt. 3. Das Militarwesen), 317-612. 

'See Capt. C. F. Atkinson: Encyclop. Britan., Cambridge, 1910, II, 595. Mommsen discusses this 
matter in his History, particularly in his account of the masterly inactivities ("Fabian policy") of 
Quinlus FabiuB Maximus (II, 148-153). 



Rome 51 

Status of Military Medicine under the Roman Republic 
Before the ascendancy of Julius Caesar (54—44 B.C.), who gave to 
physicians the right of citizenship, medicine, as practiced by the Greeks, 
was despised in Rome, and mihtary medicine was non-existent. Greek 
physicians were scorned, as taking fees, and feared, as possible poisoners. 
Roman medicine was domestic and herbal medicine, with knowledge 
of a few haemostatic remedies^^ and the usual accompaniment of super- 
stitious observances related to the household gods. Cato the Censor 
boasted that ancient Rome was "without physicians, but not without 
medicine" {sine medicis sed non sine medicina) and treated every 
ailment, even wounds, with the cabbage. Pliny the Elder (23-79 A.D.), 
in the days of the Empire, voices the ancient clan-prejudice against the 
ways of the foreigner: 

For some trifling sore or other, a medicament is prescribed from the shores of the 
Red Sea; while not a day passes but what the real remedies are to be found upon the 
tables of the very poorest among us. But if the remedies for diseases were derived 
from our own gardens, if the plants or shrubs were employed which grow there, there 
would be no art, forsooth, which would rank lower than that of medicine. Yes, avow 
it we must — the Roman people, in extending its empire, has lost sight of the ancient 
manners, and we the conquerors are conquered; for now we obey the natives of foreign 
lands, who by the agency of a single art have outgeneralled our generals. (Natural 
History, XXIV. 1.) 

^Mien wounded, the Roman soldier, in this early period, was bandaged 
either by himself or by his comrades, presumably with materials carried 
about his person. That the art of bandaging was as well known to the 
early Romans as to the ancient Egyptians is apparent from Livy's account 
of the assassination of Tarquin (616 B.C.), when Tanaquil, his wife, 
"sedulously prepares everj'thing necessary for dressing the wound" 
and later assures the people that "the wound had been examined, the 
blood wiped off, that all the symptoms were favorable."" An instance 
of many soldiers bandaging themselves and feigning wounds to avoid 
service under an unpopular leader, Appius Claudius (469 B.C.) is on 
record. ^^ The pathetic image of the Dying Gaul (Capitoline Museum, 
Rome) suggests, however, the fate of the luckless, whether Roman or 
barbarian. If abandoned or left in the lurch, the wounded soldier could 
do little but crawl to shelter and die. But the Romans of the Republic 
had a kind of family interest in their citizen armj', recruited from the 
people without pay, and stood by it in the hour of need. Thus, Tacitus, 
in describing the caving in of the amphitheater of Fidena in the reign of 



'" Medicina quondam fuit paucarum scientia herbarum, quibus sisteretur Quena sanguis, vulnera 
rent. Seneca: Ad Lucilium, lib. XV, 8, ep. 3, 95. Cited by Haberling. 
" Inspectum vulnua absterso cruore, omnia salubria esse. Livy I, 41. 
"Dionysius Halicarnassensis: Antiquitates Romanorum, IX, 50. 



52 History of Military Medicine 

Tiberius (27 A.D.), refers to the solicitude of the populace for the 
50,000 killed and injured, as follows: 

The city of Rome recalled in that time of mourning an image of ancient manners, 
when after a battle bravely fought, the sick and wounded were received with open 
arms and relieved by the generosity of their country. ^^ 

In the Roman History of Livv, which shadows forth the underlying 
principles of administration for evacuation of the wounded, as we now 
know it, one can trace, chapter by chapter, the gradual evolution of the 
two fundamental concepts, viz.: (1) care of the wounded as a military 
necessity and patriotic duty; ('2) demoralization of the fighting line by 
the misery of the wounded, when the primal duty of evacuation is 
neglected. 

Thus, as early as 502 B.C., we find that it was customary for the 
Roman armies to take their wounded with them after a battle, to 
remain with them until they were in condition to be moved or to leave 
them in a safe place: 

502 B.C. (A.U.C. 252). "The consul was left among many more who were 
wounded, with very uncertain hopes of his recovery. After a short time, sufficient 
for curing their wounds and recruiting their army, they marched against Pometia 
with redoubled fury and augmented strength." (II, 17). 

"421 B.C. (Volscian Wars): "Taking with him all the wounded he could, and not 
knowing what route the consul had taken, he (Tempanius) proceeds by the shortest 
roads to the city" (IV, 39). 

Later on, billeting or cantonment hospitalization was common: 

212 B.C. "But none of the enemy coming out against them, they gathered the 
spoils at their leisure and collecting the bodies of their own troops into a heap, burnt 

them As soon as daylight discovered the flight of the enemy, Marcellus, 

leaving his wounded under the protection of a small garrison at Xumistro, in com- 
mand of which he placed Lucius Furius Purpureo, a military tribune, commenced a 
close pursuit of Hannibal and overtook him at Venusia" (XXXVII, 33). 

203 B.C. "The wounded were then conveyed into the town of .^bura, and the 
legions marched through Carpetania, against Contrebia" (XL, 33). 

In 478 B.C., we find Fabius Maximus leaving his wounded in the 
houses of patricians, particularly of his own family: 

478 B.C. "And not unmindful of that which he had conceived at the beginning 
of his consulate, namely the regaining of the affection of the people, he distributed 
the wounded soldiers among the patricians to be cured. Most of them were given 
to the Fabii; nor were they treated with greater attention in any other place. From 
this time on the Fabii began to be popular, and that not by any practices except 
such as were beneficial to the state" (II, 47). 

Desertion of the wounded in a tight place was more common among 
the Volscians and Carthaginians than the Romans: 

421 B.C. (Volscian Wars): "Such a panic seized both camps, from their un- 



""Fuitque orbs i>er illos dies, quamquam maesta facie, veterum iostituti similis, qui magna post 
proelia saucios largitione et cura sustentabant." Tacitus, Annales, IV, 63. 



Rome 53 

certainty as to the issue, that, leaving behind their wounded and a great part of their 
baggage, both armies, as if vanquished, betook themselves to the adjoining moun- 
tains" (IV, 39). 

341 B.C. (Conflict with the Hernicians): "Many fall on both sides; more are 
wounded. . . . Next day the camp of the Hernicians was deserted, and some 
wounded men were found left behind" (VII, 8). 

3-10 B.C. "The Volscians, reckoning up what men they had lost in battle, had by 
no means the same spirit to repeat the risk. They went off in the night to Antium 
as a vanquished army in the utmost confusion, leaving behind their wounded and 
part of their baggage" (VIII, 1). 

As late as 210 B.C. we find Marcellus unable to follow up his victory 
over Hannibal on account of solicitude for his wounded: 

210 B. C. "The following night, Hannibal decamped. The great number of the 
wounded prevented Marcellus from following him as he desired" (XXVII, 2). 

Early in the Samnite Wars it had been found that the presence of 
the wounded at the front after a battle had a deplorable effect upon the 
morale of the command: 

295 B.C.: "They all assured him that they would do everything in their power, 
but that the soldiers were quite dejected; that, from their own wounds, and the 
groans of the dying, they had passed the whole night without sleep; that if the 
enemy had approached the camp before day, so great were the fears of the troops, 
they would certainly have deserted their standards" (X, 35). 

The bad effect of epidemic disease upon morale is emphasized in the 
account of the siege of Syracuse, and it is of interest to note here 
that the sick were attended and cared for, perhaps by comrades, if not 
by women: 

212 B.C.: "They were visited too by a plague; a calamity extending to both 

sides, and one which might well divert their attention from schemes of war 

The intolerable intensity of the heat had an effect upon the constitution of almost 
every man in both camps. At first they sickened and died from the unhealthiness 
of the season and the climate; but afterwards the disease was spread by merely 
attending upon and coming in contact with those affected'*; so that those who were 
seized with it either perished, neglected and deserted, or else drew with them those who 
sat by them and nursed them, by infecting them with the same violence of disease." 
Daily funerals and deaths were before the eye, and lamentations were heard from all 
sides, day and night. At last their feelings had become so completely brutalized by 
being habituated to these miseries, that they not only did not follow their dead with 
tears and decent lamentations but they did not even carry them out and bury them; 
so that the bodies of the dead lay strewn about, exposed to the view of those who were 
awaiting a similar fate; and thus the dead were the means of destroying the sick, and 
the sick those who were in health, both by fear and by the filthy state and the noisome 
stench of their bodies. Some, preferring to die by the sword, even rushed alone upon 
the outposts of the enemy" (XXV, 26). 



i« "Curatio ipsa et contactus aegrorum vulgabat morbos." 

'* " Aut assidentes curantesque eadem vi morbi repletos secum traheret." This is exceedingly in- 
teresting as showing that Liv-y (59 B.C. -17 .\.D.) had, in his time, some notion of contagion, to which 
the Greeks were blind. VirgLl, living in the same period, is aware of the possibility of contagion among 
cattle: " Nee mala vicini pecoris contagia laedent." Eclogue, I, 51. 



54 History of Military Medicine 

It was sometimes dangerous for a Roman commander to neglect his 
wounded; his soldiers would not fight for him if he did: 

323 B.C.: "The experienced commander quickly perceived the circumstances 
which prevented his success, and that it would be necessary to moderate his temper, 
and to mingle mildness with austerity. Accordingly, attended by the lieutenants- 
general, going around to the wounded soldiers, thrusting his head into their tents, and 
asking them, one by one, how they were in health; then mentioning them by name, he 
gave them in charge to the officers, tribunes and prefects. This behavior, popular 
in itself, he maintained with such dexterity that by his attention to their recovery 
he gradually gained their affection; nor did anything so much contribute to their re- 
covery as the circumstances of this attention being received with gratitude. The 
army being restored to health, he came to an engagement with the enemy, and both 
himself and the troops being possessed with full confidence of success, he so entirely 
defeated and dispersed the Samnites that that was the last day they met the dictator 
in the field" (VIII. 36). 

At the battle of Nadogare (204 B.C.), the Carthaginians even drove 
away their panic-stricken and wounded in order not to demoralize that 
part of their fighting line which was holding its ground : 

204 B.C.: "Not even then, however, did they receive unto their line the terrified 
and exasperated troops, but closing their ranks, drove them out of the scene of 
action to the wings and the surrounding plain, lest they should mingle these soldiers, 
terrified with defeat and wounds, with that part of their line which was firm and 
resh" (XXX, 34). 

In the same battle, Scipio Africanus had already some arrangement 
for evacuating his wounded to the rear during the engagement: 

204 B.C.: "Scipio, perceiving this, promptly ordered the signal to be given for 
the spearmen to retreat, and having taken hiswounded to the rear (pos/remam in aciem) 
brought the principes and triarii to the wings, that the line of spearmen in the center 
might be more strong and secure" (XXX, 34). 

That more died from battle wounds than were killed did not escape 
the attention of the historian : 

310 B.C.: "And among the Romans, so numerous were the wounds that more 
wounded men died after the battle than had fallen on the field" (IX, 32). i* 

Observations of this kind, in which Livy is more profuse than any 
other historian, undoubtedly had their weight in bringing to pass an 
organized medical service for the Roman Army, mainly on account of the 
effect of such losses upon military operations. 

The argument of one of the lost books of Livy (Book LVII) records 
the terrible dressage initiated by Scipio Africanus as a measure against 
prostitution in cantonment areas; but it is not known whether this lost 



""Et apud Romanos tantum vulnerum fuit, ut plures post proelium paucii decesserint, quam 
ceciderant in acie" Livy, IX, 32. 



Rome 55 

book contained any reference to venereal disease, over and above the 
obscure allusions in Martial and Juvenal: 

Scipio Africanus laid siege to Xumantia (B.C. 133), and restored to the strictest 
military discipline the army, which had been corrupted by licentiousness and 
luxury; this he efiFected by cutting off every kind of pleasurable gratification; driving 
away the prostitutes who followed the camp, to the number of two thousand; keeping 
the soldiers to hard labor, and compelling every man to bear on his shoulders pro- 
visions for thirty days, besides seven stakes for their fortifications. To any one who 
lagged behind on account of the burden, he used to cry out: "When you are able to 
defend yourself with your sword, then cease to carry your fortification"; he ordered 
another who carried with ease a small shield, to bear one unusually large; and not 
infrequently ridiculed them for being more expert in managing their shields for the 
defence of their own bodies than their swords for the annoyance of those of the 
enemy. When he found any man absent from his post, he ordered him to be flogged 
with vine twigs, if a Roman; if a foreigner, with rods. He sold all the beasts of 
burden, that the soldiers might be forced to carry their own baggage. He engaged 
in frequent skirmishes with the enemy, with good success. 

That Roman barracks were still huts of the Homeric type, even dur- 
ing the second Punic War, is also recorded by Livy: 

212 B.C.: "He had compelled his soldiers, withdrawn from the houses, to build 
themselves huts after the military manner, near the gates and walls; at once, that the 
houses of the city might be let and occupied with the land, and also through fear, 
lest the excessive luxury of the city should enervate his troops as it had those of 
Hannibal. Now most of these were formed of hurdles and boards, others of reeds 
interwoven, all being covered with straw" (XXVII, 3). 

In the Etruscan Wars, winter huts were a novelty: 

402 B.C. (War with Veii): "When the Roman generals conceived greater hopes 
from a blockade than from an assault, winter huts also, a thing quite new to the 
Roman soldier, began to be built. . . . They were harassed and worked much 
more severely than those of Veii. For the latter spent the winter beneath their own 
roofs, defending their city by strong walls and its natural situation, whilst the Roman 
soldier, in the midst of toil and hardship, continued beneath the covering of skins, 
overwhelmed with snow and frost, not laying aside his arms even during the period 
of winter, which is a respite from all wars by land and sea" (V. 2). 

The following passages in Livy are of particular importance as 
showing that the bandaging of wounds, by soldiery themselves, was a 
commonplace procedure in the earlier Roman armies: 

448 B.C.: "While stripping the body of his enemy, he (Herminius) himself re- 
ceived a wound with a javelin; and though brought back to the camp victorious, yet 
he died during the first dressing of it" (II, 20). 

351 B.C.: "The consul (Marcus Popillius Laenas), having his left arm well-nigh 
transfixed with a javelin, while he exposed himself incautiously in the van, had 
retired for a short while from the field, and now, by the delay, the victory was on 
the point of being relinquished, when the consul, having had his wound tied up, 
riding back to the van, cries out, 'Soldiers, why do you stand,' etc." (VII, 24). 

That Roman commanders themselves were sometimes expert in 



56 History of Military Medicine 

wound treatment, and attended their own men, is recorded by both 
Dionysius and Polybius: 

"When the consul ^milius, after the defeat of the Volscians, had set up a camp 
at Longula, he remained there and restored the wounded with remedies" (Dionysius, 
VIII, 35). 

Publius Cornelius Scipio, severely wounded in the battle of the Trebia (220 B.C.), 
"occupied himself with the treatment of his own wounds and those of his comrades" 
(Polybius, III. 66, §9). 

As we approach the period of JuHus Caesar, evidences of the exist- 
ence of wound surgeons (medici vulnerarii) in the Roman army become 
more definite. Archagathus, the first Greek physician to settle in Rome 
(219 B.C.), was called by the people vulnerarius, on account of his 
surgical skill, and carnifex (executioner) on account of his lethal opera- 
tions. He was forced to leave the city. Cicero, in his second Tusculan 
Disputation (circa 70 B.C.), says: 

If we notice how the wounded, borne in from the line of battle, behave themselves, 
it will not escape our observation that raw recruits make shameful outcries over slight 
wounds, while the experienced, seasoned soldier is pluckier and merely looks around 
for a surgeon to apply the dressing." 

Virgil (70-20 B.C.) introduces the aged wound-surgeon, lapyx, and 
the physician-priest, Umbro, as stock figures in the .^neid (VII, 756; XII, 
396), with accounts of wound-treatment (XII, 387; 400; 411). Caesar 
himself, distributed his wounded in places occupied by Romans, ^^ and 
his subaltern field-commander, Labienus, had advanced far enough in 
methods of evacuation to send his wounded to Adrumentum in wagons 
for treatment (46 B.C.).i» 

But the great improvements that were to come in Roman medico- 
military administration were bound up with the advancement of 
medicine in Rome by Greek physicians. 

Greek Medicine in Rome 

The story of the introduction of Greek medicine into Rome has 
recently been told with unapproachable skill and charm by Sir Clifford 
Allbutt, to whose pages the reader may be referred for the extraordinary 
array of minutiae which have accumulated about this phase of history, 
through the labors of medical philologists. The matter was of greatest 
moment for the future medical administration of the Roman army as it 
meant the gradual breaking down of the ancient Latin prejudice against 
medical science, the actual residence in Rome of the greatest physicians 



1' "Quin etiam videmus ex acie efferri saepe saucios, et quidem rudem ilium et ineiercitatum quam 
vis levi ictu ploratus turpissimos edere; at vero ille exercitatus ob earn rem fortior, medicum modo 
requirens, a quo obligetur. Cicero: Disp. Tusc. iv, 16, 38. 

i» Caesar: De hello civUi III. 75; 78. 2. 

""Saucios in plaustria deligatos jubet Adrumentum deportari." Caesar: De bello Africano, 21. 



Rome 57 

of the period, and the eventual participation of Roman citizens them- 
selves in the civil and military practice of medicine. 

The prejudice of the Roman citizen against Greek physicians was 
due to the fact that the first to come into the city were slaves (servi 
mediei), who were sometimes employed to poison enemies by their 
masters. Archagathus, the first Greek physician to settle in Rome 
(220 B.C.), was, however, accepted as a Roman citizen and had an 
oflSce (taberna) near the Forum Marcelli. 

Greek medicine acquired consideration and esteem through the 
superior abilities of Asclepiades of Prusa (Bithynia), who settled in 
Rome in 91 B.C. and lived to an extreme old age. 

Extolled by Celsus and Scribonius Largus, reviled by Pliny and Galen because of 
his Alexandrian training, Asclepiades had many of the traits of the "society physi- 
cian." His observation that Nature is as likely to kill the patient as to cure him was 
reiterated by Sir William Gull in a conversation with Huxley. A master of rhetoric 
and sophistry, Asclepiades was alive with the discriminating intelligence of the 
Greek. He inculcated the atomic theory of Democritus, held that the "soul" is not 
an entity but the sum of the functions of the body, experimented with decerebrated 
animals, differentiated mental disorders from the cerebral manifestations of disease 
other than those of the brain, and won over the Romans by his mild and rational 
system of physiological therapeutics (diet, baths, gymnastics, massage, etc.). His 
voluminous writings have been lost and he exists for us only in a few fragments and 
stray references. 

Celsus, who flourished in the reign of Tiberius Caesar (14-37 A. D.), 
was inferentially a Roman citizen, who compiled the most valuable 
encyclopaedia of medicine and surgery in antiquity. This work, mainly 
derived from Greek sources, shows the notable advances made in the 
practice of medicine during the five centuries between Hippocrates 
and the Christian era. The degree of specialization attained is fairly 
indicated in the titles of some of the chapters, e.g., on diseases of the 
colon, on the varieties of phthisis, on diseases of the stomach, liver, 
spleen, kidneys; on diseases of the skin, ears, eyes, nose, mouth, tonsils; 
on wounds of the intestines, on hernia, varix, varicocele, gangrene, etc. 
The chapter on military surgery is entitled "On the extraction of 
weapons from the body,"-" and is of particular interest as showing that 
stones and leaden bullets, discharged by the Balearic slingmen or the 
ballistic apparatus, were sometimes lodged in the body, even before 
the days of firearms: 

"When foreign substances, such as weapons, have penetrated the body, their 
extraction is frequently attended with great trouble. There is some difficulty arising 
from the different kinds of them, and sometimes from the nature of the parts they 
have penetrated. Now every weapon is extracted, either in the direction by which 
it entered, or in the point to which it tends; in the first case it returns by the same 
passage itself has made; in the latter it must receive its exit from the scalpel. For 

'"CeUus: De re medica, vii, 5. Transl. by Alex. Lee, London, 1831, 234-239. 



58 History of Military Medicine 

the flesh must be incised over the weapon's point. But if the weapon have not 
pierced far, and is only under the surface of the flesh, or at least have not passed 
through large veins and nervous parts, the best plan is to remove it by the way it 
entered. 

But if the space through which the weapon has to return be more than that which 
is to be laid open, and it has already passed through veins and nerves, it will be 
more advisable to open what remains, and to extract it in that direction; for it 
will be found nearer, and drawn out with greater safety; and when the weapon has 
passed beyond the middle of one of the larger limbs, it will heal the sooner for being 
pervious, as the wound may be dressed at both e.xtremities. 

But if the weapon is to be withdrawn by the same way it entered, the wound 
must be enlarged by the scalpel, in order that it may pass the more easily, and pro- 
duce less inflammation, which will be greater if the flesh be lacerated in withdrawing 
the weapon. Again, if a counter-opening is to be made in any part, it ought to be so 
large, that the weapon may not increase it in transit. In either case, the utmost 
care should be employed, lest a tendon, or large vein, or artery be divided. 

When any of these are exposed, it must be seized by the blunt hook, and held 
aside from the knife. But when the incision has been made suflBciently large, then 
the weapon must be taken out by the same means, and the same circumspection is 
to be used, lest any of those parts which I have already mentioned be injured whilst 
the weapon is being taken out. 

The preceding observations are general; but there are certain peculiarities in the 
several kinds of weapons which I shall subjoin immediately. Nothing penetrates 
the body with greater facility than an arrow; and it also lodges at the greatest depth. 
Now this happens, both because it is propelled with great force, and because it is in 
itself of a narrow slender form. Therefore it must be withdrawn more frequently 
from the opposite part, than from the one on which it entered; and that especially 
since it is mostly surrounded with barbs, which lacerate more by a retrograde motion, 
than when extracted in the opposite direction. A counter-opening being made, 
the flesh ought to be drawn apart by an iron instrument made in the form of the 
Greek letter A: then, when the point has appeared, if the shaft adhere, it must be 
propelled forward until it can be seized on the opposite side and extracted; but if the 
shaft have been detached, and only the iron head remain within, the part must be 
grasped either by the fingers or by the forceps, and so drawn out. 

Neither is there any other method of extracting it, when it is considered advis- 
able to remove it by the orifice it came. For the wound being enlarged, either the 
shaft, if there, is to be extracted, or, if not there, the iron head itself. But if the 
barbs are discovered, and they appear to be short and small, they ought to be broken 
there by the forceps, and the weapon freed from these to be drawn out: but if these 
barbs be large and very strong, they are to be covered by split writing-reeds, and so 
extracted, lest they should lacerate any part. These observations are to be followed 
in extracting arrows. 

But if a broad weapon were lodged in the body, it is improper to dislodge it by 
a counter-opening, lest we add another large wound to the one already made by the 
weapon itself. Therefore it is to be extracted by a certain kind of iron instrument 
which the Greeks denominate the graphiskos of Diodes, because Diodes was the 
inventor of it, whom I have already noticed as the greatest among the ancient 
physicians. Namely, a plate of iron, or even of brass, at one end having two hooks 
turned downwards on each side: the other end is folded or turned up on each side, 
and the extremity slightly curved towards that part which is bent, and it is also 



Rome 59 

perforated there. This is introduced transversely near the weapon; and then, when 
it has reached the farthest point of it, it is to be turned a little, so that it may receive 
the weapon in its opening. When the point is in the perforation, two fingers are to 
be applied to the hooks at the other end, when the instrument and weapon are to 
be extracted at the same time. 

The third kind of missile which ought to be extracted sometimes is a leaden 
bullet, or stone, or something similar, which having perforated the skin, becomes 
entirely concealed there. In all such cases, the wound must be enlarged, and the 
foreign body must be withdrawn with the forceps by the way it entered. 

The operation is more difficult in every wound, if the foreign body is either 
fixed in a bone, or has plunged itself in a joint between two bones. In the bone, the 
weapon must be moved to and fro till it becomes detached where it was grasped at 
the point; and then the weapon may be extracted either with the hand or forceps, 
as in drawing a tooth. By this method, it scarcely ever happens that the weapon 
is not brought away: but if it still remains, it may be dislodged by striking it with 
some iron instrument. The last resource, when we have failed to remove it, is to 
perforate the bone near the part with a trephine, and from that opening to excise 
the bone in the form of the letter V, so that the lines may converge towards the point 
of the weapon; this being done, it must necessarily give way, and be easily extracted. 

But if it has penetrated the articulation between two bones, the two limbs are 
to be bound up with bandages or straps, in the vicinity of the wound; these are to 
be drawn in contrary directions, in order to put the tendons on the stretch; which 
being done, the space between the bones is enlarged, so that the weapon may be with- 
drawn without difficulty. Care must be taken, as I have observed in other places, 
that no nerve, vein, or artery, be wounded by the weapon in the act of extracting 
it; and this may be prevented by the same means which I have already mentioned. 

But if any person has been wounded by a poisoned weapon, the same means 
must be employed in every respect, and with all possible celerity, as if poison had 
been drunk, or as if stung by a serpent. When the weapon is extracted, the wound 
itself requires no other dressing than that which would be necessary if nothing had 
lodged there; concerning which I have said enough in another place." 

Contemporary with Celsus were three eminent surgeons, Heliodorus, Archigenes 
and Antyllus, and a little later Dioscorides, in the reign of Nero (54-68 A.D.) wrote 
the first book on materia medica. Aretaeus (2-3 Century, A.D.) wrote a book on 
practice, the most remarkable in antiquity for literary elegance, but mainly derived 
from Archigenes. Two Ephesians, Rufus and Soranus, both of the 2d Century, 
A.D., are also outstanding figures in the medical literature of the period. The period 
closes with the great name of Galen (131-201 A.D.), the greatest experimenter in 
physiology among the ancients, the most voluminous of all the ancient physicians. 
Galen did much for the comparative anatomy and physiology of the nervous and 
locomotor systems, was the first to observe aneurism, stated the four classical symp- 
toms of inflammation, and devised many improvements in therapy, particularly the 
use of milk diet and climatic treatment in phthisis. A practitioner of unusual 
shrewdness, he wrote the first tract on malingering or feigned diseases, which was 
translated three times in the 16th century, and latterly by Frolich.'^ The Galenic 
system dominated European medicine for nearly seventeen centuries. 

By the lex Julia (90 B.C.), Roman citizenship had been conferred 
upon all native Italians and in 4G B.C., Julius Caesar, as Suetonius 



"Frolich: Friedreich's Bl. f. gerichU. Med., Niirnb., 1889, iv, 21-26. 



60 History of ^Iilitary Medicine 

relates, "conferred citizenship on all practitioners of medicine and all 
professors of liberal arts in Rome, to make them more desirous of living 
in the city and to induce others to come there. "^^ In the opinion of 
Marquardt, this far-sighted policy was an expression of Caesar's desire 
to do something for the medical service of the Roman Army.^^ The 
city began to swarm with physicians, eager for the jus quiriiium, and 
the Roman Quirites themselves no longer disdained to study medicine. 
Roman physicians, such as Cassius Felix or Scribonius Largus, had 
already attained distinction in medical literature, and later Antonius 
Musa became the intimate of Horace and the physician to Augustus 
Caesar. Scribonius Largus served with Claudius in Britain. Galen 
was invited to accompany ^larcus Aurelius on his campaign against the 
Marcomanni. 

Battle Losses in Antiquity ^^ 

In the later Greek and Roman historians, we begin to get definite statistics of 
battle losses, and while the figures given are large and obviously approximations, 
it is assumed by Frolich that they are in the main correct, for the following reasons: 
(1) The aim of ancient armies was not merely to cripple the enemy's forces, but to 
destroy them utterly, which, in itself, would imply a high mortality on the losing 
side. (2) In the German wars, it was impracticable and impossible for the Romans 
to take care of a great horde of captives and vice versa. (3) The Persian and Ger- 
manic thrusts were almost in the nature of folk-migrations, homeless, formless cara- 
vans of people, risking their all, without any reserve forces to rely upon, and even 
accompanied by women and children. It may further be noted that the lustration 
of Roman troops before and after a battle, in connection with the recruiting of the 
army by the census, constituted a very real check upon the actual numbers engaged 
and the losses sustained. After Caesar's bloody battle with the Helvetians in 58 
B.C., a similar count of the total population and the number available for warfare 
was found to be inscribed on tablets in the Helvetian camp. 

At Marathon (490 B.C.), 10,000 Athenians are said to have engaged 210,000 
Persians, with losses of 192 Greeks and 6,400 Persians. At Plataea (479) B.C., 
105,000 Greeks opposed 325,000 Persians with a loss of only 1,360 Greeks and the 
utter routing of the Persian forces. Of the 23,000 Greeks who marched with Cyrus 
against Artaxerxes in 401 B.C., only 8,000 returned. As we approach the Roman 
period, figures become more credible. At Asculum (280 B.C.), Pyrrhus lost 3,500 
men. In the second Punic war, Regulus lost 13,500 men out of 15,500 in Africa. 
Hannibal started across the Alps in 218 B.C. with 100,000 infantry and 12,000 
cavalry and had only 20,000 infantry and 6,000 cavalry when he reached Italy. In 
his victory at Lake Thrasymene, (217 B.C.), 13,000 Romans were destroyed and 
10,000 taken prisoner, while the Carthaginians lost but 1,500 in battle, many more 
dying of wounds later. At Cannae (216 B.C.), the Romans suffered the staggering 
loss of 60,000 killed and 10,000 taken prisoners, out of an army of 85,000. Hasdrubal 
lost 56,000 out of 60,000 at Metaurus (207 B.C.) and Hannibal 20,000 killed and 



""Omnisque medicinam Romae profeasos et liberalium artium doctores, quo libentius et ipsi 
urbem incolerent et ceteri adpeterent, civitate donavit" Suetonius, Divus Julius, 42. 

'• Marquardt & MommBen: Handbuch der romischen Alterthiimer, 2 aufl., Leipzig, 1884, v, 556. 
"Frfilich: Ztschr. f. Krankenpflege. Berl., 1896, xviii, 41-45. 



Rome 61 

20,000 prisoners out of 50,000 at Zama {i02 B.C.). When Carthage was destroyed 
in 146 B.C., the city of 700,000 inhabitants had been reduced to 50,000 by the Punic 
Wars. In the Civil War of 49 B.C., 170,000 out of 320,000 Romans were destroyed 
In 113 B.C., 300,000 Cimbri began to migrate southward and eventually slaughtered 
120,000 Romans (105 B. C). In 102, Marius destroyed 200,000 Teutons at Aquae 
Sextiae and took 80,000 prisoners; in 101, 130,000 out of 150,000 Cimbri were killed. 
In 58, Caesar slaughtered 238,000 Helvetians and in the same year, defeated Ario- 
vistus, who lost 80,000. In 57, Caesar destroyed 55,000 out of 60,000 Nervi on the 
Sambre. At the destruction of Jerusalem (70 A.D.), it is recorded by Josephus 
(VII, 17), that 1,100,000 were slain. In the revolt of the Jews against Hadrian 
(133 A.D.), 60,000 were slain. The great epidemics of the past, e.g., the plague at 
Athens, described by Thucydides and Lucretius, the Orosian, Cyprian and Antonine 
plagues, the epidemics attacking the Carthaginian forces at Agrigentum and Syracuse, 
also occasioned frightful mortality; and the introduction of malarial fever into 
Greece is held by Jones'^ to have been the cause of the decline of the Hellenic civili- 
zation. 

Later Organization of the Roman Army^^ 

Before the bloody period of the Civil Wars, the Roman Army had 
been recruited by a census of property-holding citizens. In course of 
time the heavy infantry of the line, made up of the middle classes, 
came to be selected not according to property qualifications but by length 
of service, and the Italian allies (socii) had long since been permitted 
to serve. Following the Civil Wars, still more important changes were 
effected by Gains Marius (155-86 B. C), a man of humble origin, whose 
military abilities had advanced him from the plow to the consulship by 
107 B. C. Before his time, the aristocracy had long since given up 
service in the army, the middle class had almost ceased to exist, the 
allies (heavy troopers from Thrace, light African cavalry, Ligurian light 
infantry and Balearic slingers) made up the main contingent, and vol- 
untary enlistment of the poor had become customary. In 107 B. C. 
Marius made voluntary enlistment accessible to all. The maniples 
were now replaced by heavy cohorts, ten of which made a legion of 
6,000 men. This dense rigid formation became necessary, as in the 
Napoleonic wars, through "the decline in morale of the rank and file" 
(Atkinson). "The morale of the Roman army was founded no longer on 
patriotism but on professional pride and esprit de corps" (Atkinson). 
These paid soldiers were usually enlisted for life; training was uniform, 
promotion mechanical, service became entirely professional, and as 
Mommsen says, the silver eagle of the legions "proclaimed the advent 
of Emperors." This new standing army proved, however, to be the 
salvation of Rome during the bloody periods of the Civil and German 
wars. When Octavius Caesar came to power after the battle of Actium 

" W. H. S. Jones: Malaria and Greek History. Manchester, 1909. 
" Atkinson, op. cil., 595. 



62 History of Military Medicine 

(31 B. C). he had upon his hands a great army variously distributed. 
This he cut down to a select force of 25 legions, while the Pretorian 
guard, destined to become the enemies of the people and the assassins 
of many emperors, occupied and guarded Italy. In such a standing 
army of 300,000 picked men, with long terms of enlistment, the need 
for some sort of medical organization and administration was obvious 
and the means of effecting it were happily supplied by the improved 
social status of physicians and of medical practice in Rome. 

Establishment of a Medical Service in the Roman Army 

Evidence on this matter is scattered and tangential, for the reason 
noted by French physicians in the eighteenth century, viz., that secular 
historians seem to be in a conspiracy to omit all mention of medicine 
from their writings.^^ Even in the reign of Vespasian (69-79 A. D.), 
when the Roman army consisted of 30 legions, 10 Pretorian cohorts and 
auxiliary troops, medicine was still regarded as a "negotiinn sordidum." 
The Constitutiones or legal enactments of Augustus, containing his 
prescriptions for the reorganization of the Roman army, have unfor- 
tunately been lost,^^ but that he must have made due provision for a 
medical establishment may be inferred from the fact that he gave to 
all free physicians (including educated army surgeons) the equestrian 
dignity {dignitas equestrisY'^ which conferred the right of full citizenship 
with the privilege of wearing the ring of the knightly class. That 
educated physicians (medici) were attached to the Roman Army before 
the Christian era is evident from passages in Cicero (70 B. C), Celsus, 
Galen, Lucian, and the Platonist Onosander.^" In the Tactics of Clau- 
dius iElianus (100-140 A.D.), dedicated to Emperor Hadrian, they are 
distinctly classed among non-combatants (a^uaxoi)^^ and the services 
of legionary physicians (medici legionis) are commemorated in some 46 
Latin inscriptions of the Empire (lst-2d Century, A.D.).^^ Early in 
the Christian era, marked solicitude for the wounded, whether real or 
affected, became an almost official trait or social obligation of the Roman 
emperors. The crafty Tiberius (14-37 A.D.) won the favor of his 
troops on his Illyrian campaign by taking with him physicians, litters 



" Dujardin & Peyrilhe: Histoire de la chirurgie, Paris, 1774-80, ii, 386, Cited by Corlieu. 

"Jans: Geschichte der Kriegswissenschaft, Munchen & Leipzig, 1889, 84. Cited by Ilaberling. 

" Dio Cassius, liii, 30, Cited by Haberling. 

•"Cicero: Tusc. Diap., ii, 16, §38. Celsus: De re medica. Proaemium. Galen: Opera, ed Kiihn, 
xiii, 551; 786; xiii, 604; 1031. Lucian (Teubner ed.) Leipzig, 1852, ii, 10. Onosander: ed. KSchly 
Teubner), i, §§ 13-14, pp. 5-6). Cited by Haberling. 

" In: Griechische Kriegsschriftsteller (Kochly & Rustow), Berlin, 1855, pt. 2, 248. Cited by Haber- 
ling. 

'2 Haberling: Die altromischen Militararzte, Veroffentl, a. d. Geb d. MU.-San.-Wesens, Berlin, 
1910,19-76. 



Rome 63 

and a special bath for the wounded. ^^ Germanicus, on the northern 
marches, reheved the wants of his soldiers at his own expense, "visited 
the sick, applauded their bravery, examined their wounds,"^^ while 
his wife, Agrippina "took upon herself the functions of a general officer, 
attended to the wants of the men, distributed clothes to the indigent 
and medicine to the sick (Tacitus).^* Trajan (98-117), most firm and 
able of the emperors, was praised by Pliny and Dio Cassius for paying 
for the care of sick soldiers out of his own pocket and visiting the wounded 
in their tents after a battle. ^^ This was also the custom with his suc- 
cessor Hadrian (117-138) and of the later emperors, including Alexander 
Severus (222-235) who said that he cared more for his soldiers than 
himself, since upon their welfare hinged and hung the welfare of the 
state.^^ The aphorism of Aurelian (270-275) : "Free medical treatment 
for the soldier" (Milites a medicis gratis curentur), might well be 
inscribed over every military hospital. This royal solicitude for the 
disabled soldier in a long succession of emperors implies, in itself, a 
definite organization of hospitals and personnel for the care of the sick 
and wounded in campaign. 

While no date can be assigned for the establishment of such an elabo- 
rately organized medical personnel as is apparent from the carved 
inscriptions, it is fair to assume that by the time of Trajan and Hadrian 
(98-138 A.D.), every closed formation, every legion, every warship had 
attached to it a physician. The column of Trajan, commemorating 
his victories in the Dacian campaign, shows army surgeons bandaging 
the wounded and wearing the arms and uniform of the legionary troops. 
The grammarian Hyginus, who lived sometime in this period, dedicated 
to Trajan his book on the munitions of Roman camps (De munitione 
castroTum) , which contains an account of Roman military hospitals, 
the very existence of which implies a well-organized medical personnel. 

Accepting the conservative conclusions of Kiihn, Briau, Gaupp, 
Frolich, Marquardt, Haberling and Withington, the following may be 
inferred from the scattered information conveyed in the Latin writers, 
the inscriptions and the Digests of the Roman laws: 

Each of the 25-30 legions, of 10 cohorts each (numbering 6500- 



""Jam medici, jam apparatus cibi, jam in hoc solum portatum iastrumentum balioei nullius 
[militis] non succurrit valetudini" Velleius Paterculus: Ilistoria Romana, Li, 114, §1 (Teubner, 1876, 
p. 115). Cited by Haberling. 

""Germanicus . . . propria pecunia militem juvit. Utque cladis memoriam etiam comitate 
leniret, circumire saucios, facta singulorum extollere; vulnera intuens alium spe, allium gloria, cunctoa 
adloquio et cura sibique et proclio firmabat. Tacitus; Annales, i, 71. 

""Sed femina ingens aaimi munia ducis per eos dies induit, militibusque, ut quis inops aut sauciuB, 
vestem et fomentem dilargita est" Tacitus: Annales, i, 69, cited by Frolich. 

"Pliny, Panegyr. in Trajan, 13; Dio Cassius, 68. Cited by Frolich. 

" Milites se magis servare, quam se ipsum, quod salus publica in his esset. ^flius Lampidius 
Ilistoriae augustae scriptores sex, cap. 47. Cited by FrOlicli. 



64 History of Military Medicine 

7000 men in all) had a legionary physician {medicus legionis); each of 
the 9 Pretorian cohorts, the 4 urban cohorts and the 7 cohorts of vigiles 
(who acted as police and firemen in the city) had four cohort surgeons 
{medici cohortis) . Every body of auxiliary troops and every ship of the 
Pretorian fleet had also physicians. All these physicians, as part of the 
military establishment, were regarded as immunes, exempt from guard 
and combat duty or day labor, and ranked among the principales 
(non-commissioned officers). In the Pretorian and city cohorts, they 
were required to be Roman citizens, while the physicians of the vigiles 
and auxiliary troops, serving in Italy and the provinces, could be 
freedmen or foreigners. For this reason, the staff surgeons of these 
latter organizations were called medici ordinarii. The legionary phy- 
sicians were all of equal rank, had no other medical superiors and were 
subordinated only to the camp commander (praefechis castrorum) or, 
in his absence, to the tribunes of the legions. The social status of the 
medical staff in this military hierarchy was that of the innumerable 
grades of non-commissioned personnel and of the highly elaborated 
bureaucracy attached to the army, which included accountants, notaries, 
registrars, secretaries and civilian functionaries of all kinds. ^^ 

Military Medicine in the hiscriptioris of the Empire 

So much of Roman history is contained in the inscriptions of the 
Republic and the Empire that this branch of epigraphy has become a 
little science in itself. The most typical and most famous of all the 
Roman inscriptions is that on the Arch of Titus (72 A. D.), which 
immortalizes the devotion of the Senate and the people to the deified 
Titus and Vespasian. ^^ 

SENATVS 

POPVLVSQVE.ROiVLVNVS 

DIVO.TITO.DIVI.VESPASL\NI.F 

VESPASIAXO.AVGVSTO 

No less than 46 different inscriptions, giving the name, organization 
and rank of some 60 Roman army surgeons, have been found in different 
parts of Italy, Germany, Austria, England, France, Holland, Switzer- 
land, Roumania, Bulgaria, Servia, Asia Minor, Egypt and Algeria. "^ 
The wide range of these finds, the gravestones of those who died in 



" Marquardt & Mommsen: Handbuch der r6inischen Alterthumer, 2. Aufl. Leipzig, 1884, v, 
554-557. 

" The majestic capital letters of this inscription, carved by the stone-cutter as if for some supreme 
occasion, are identical with those familiar to us in the beautiful font of type devised by the Venetian 
printer, Nicholas Jenson, for the medical books published by him in 1471. They are commonly seen 
on public buildings, e. g., in the inscription over the central entrance of the present Munitions 
Building, in which the Surgeon General'.'^ Office is now housed. 

•"Tlaberling: VeroflTentl, a. d. Geb. d. MU -San.-Wesens, Heft 42, Berl., 1910, 19-76. 



Rome 65 

foreign lands, is evidence in itself of the extensive medical organization 
of the Roman army during the first two centuries of the Christian era. 
Very typical is the pathetic inscription on the six-foot tombstone of a 
medicus ordinarius of the Tungrian cohort in Britain {circa 83, A. D.) 
found near the site of the Roman wall near Housesteads, and now in the 
Newcastle Museum: 

D. M. 

AXICIO 

IXGENVO 

MEDICO 

ORD. COH 

I. TVNGR 

VIX. AX. XXV. 

D[iis] M[aiiibus], Anicio Ingenuo, Medico Ord[inario] Coh[ortis] primae 
Tungr[orum]. Vix[it] An[nis] XXV. 

To the Gods of the Shades:*^ Anicius Ingenuus, Ordinary Physician of the First 
Tungrian Cohort. He lived 25 years. 

Another, found in Rome, reads: 

Asclepio et saluti commillitonum. Sex[tus] Titius Alexander, medicus Coh[ortis] 
V, pr[aetoriae] donum dedit [Imperatore Domitiano] Aug[usto] octavum T[ito] 
Flavio Sabino consulibus. 

Sextus Titius Alexander, physician to the Fifth Pretorian Cohort, dedicates this 
stone to ^^sculapius and to the health of his comrades. [In the reign of Domitian.] 
Consulate of Augustus Titus V'lII and Flavius Sabinus. 

An inscription of 155 A. D., found in Kutlovica (Bulgaria) shows that 
a detachment of the 10th (Claudian) legion had a medicus among the 
principales, whence it may be inferred that each of the 10 cohorts in a 
legion had separate medical personnel. An inscription found in IQO'J 
at Kistanye (Hungary) shows, carved underneath, a surgical case with 
instruments.^^ An inscription from Lanuvium, deciphered by Momm- 
sen, shovrs that legionary physicians did not serve continually with one 
organization, but might be transferred to others. The inscriptions of 
the Pretorian cohorts show that each of these had a surgeon, and 
sometimes also a medicus clinicus or internist. One found at Lyons 
in 1833, relating to the 13th Urban Cohort, is in memory of a medicus 
castrensis or camp physician. An inscription of the time of Hadrian, 
found at Rome, shows that the emperor's cavalry guard {equites siugu- 
lares Augusii) had a troop surgeon. Two pillars set up by the second 
and fifth cohorts of the vigiles, in honor of the emperor Caracalla 
(212 A.D.) have engraved upon them the names of four medici each,^^ 

♦' "Gods of gloom" is Swinburne's poetic translation of "V^OVLCL- or Dii Manes, i. e., the shades 
or ghostly divinities of the infernal regions or underworld. For cut of tombstone, see Haberlin?, 4j. 
•• For a cut of which see Haberling, op. cit., p. 24. 
" For a cut of which see Haberling, p. 41. 



66 History of Military Medicine 

and six of the eight names are Greek ; the second inscription gives, in ad- 
dition, the full roster of 13 officers and 1,000 privates. Other inscriptions 
show that the volunteer organizations (cohortes civium Romanorum), 
the auxiliary forces {cohortes auxiliares), the cavalry squadrons {alae 
equitum) and the triremes of the navy had each their own separate 
medical personnel. The epitaphs of the naval surgeons of the triremes 
"Cupid" and "Tiger," war vessels with a complement of about 200 
rowers and soldiers each, specify them as dwplicarii (receiving double 
pay). This compensation, Withington holds, was due to the fact that 
the Romans disliked the sea and that special inducements had to be 
held out to those undertaking this hazardous service.^* From the 56 
known inscriptions, it may be gathered that the medical administration 
of the Roman army and navy in the first two centuries of the Christian 
era was highly specialized. 

Two of the naval inscriptions, and several of the military, indicate 
that physicians could be admitted to the services at the age of 20-21. 
A letter of the emperor Antoninus Pius to the legionary physician Aulus 
Numisius suggests that continuous service was not compulsory for army 
surgeons; and a sentence in the Theodosian Codex (XIII, 3, 10) estab- 
lishes the fact that physicians practising in the city of Rome were re- 
quired to render only a minimum of wartime service {ad militiam minime 
comprehendi) .*^ In the Greek papyri of the Alexandrian period, inves- 
tigated by Sudhoff, a land-grant in Egypt, given to a veteran army 
surgeon upon his retirement, is mentioned.^® The pay of the legionary 
physician was that of the immunes, i. e., 225 denarii after Augustus 
Caesar, 300 after Domitian, 500 after Septimius Severus, while the fleet 
surgeons received twice these amounts.*^ Whether they paid for their 
medicine and instruments out of these small sums is not known. The 
uniform of the army surgeon in the reign of Trajan consisted of a double 
woolen undershirt {tunica), a short scalloped doublet {focale), leathern 
breeches {hracae) reaching to the calves, and to which the boots {caligae) 
were attached, a round metal helmet, not covering the neck, and the 
traditional short sword {gladius), attached to a belt {halieus)}^ His 
surgical kit, as described by Gurlt,^^ consisted of metal knives, scalpels, 
hooks, sounds, forceps, etc., carried in a long slender bronze case; oblong 
bronze or ivory boxes, for carrying a pocket outfit of medicines have 
also been found, with figures of ^sculapius and Hygieia, or of the yEscu- 



"E. T. Withington: Medical History, London, 1894, 118. 

" Cited by Haberling, p. 56. 

♦« K. Sudhoff: Aerztliches aus griechischen Papyrus-Urkunden. Leipzig, 1909,257-258. 

«' Haberling, p. 58. 

" Haberling, p. 59. 

" Gurlt: Geschichte der Chirurgie, Berlin, 1898, i, plates ii-iii. 



Rome 67 

lapian snake, on the covers.'" The metal field-cases of salves have 
been described by DenefTe.^' Tacitus mentions the loss of bandaging 
material in the contest between Caecina and Arminius in the German 
morass,*^ and it is related of Trajan that "when his bandages began to 
give out he did not spare his own clothing, but tore it into strips in order 
to bind up the wounds of his soldiers."^' 

The social status of the Roman army surgeon was not high, his pay 
and uniform being that of the ordinary soldiery, with whom his name is 
grouped on the inscriptions; and from this low estate he was never 
advanced. But in order to attract physicians to the military service 
and to retain them in it, certain legal privileges were extended. In 
the Justinian Codex (X, 53 (52), 1, 6), it is specified that a legionary 
physician was to be exempted from the performance of public works, 
while on military duty, but not after, unless he elected to serve abroad 
for a long period, in which case he should later enjoy the privileges of 
state physicians. Another privilege was the so-called jus restitidionis 
or "right of indemnification" (Digests, IV, 6, No. 33), in virtue of which 
a military physician was entitled to restitution for any material damage 
or fraud perpetrated against him while absent on field duty. This 
privilege was limited by Alexander Severus to a year, but was later 
extended by Gordian to four years, while, in the opinion of the jurist 
Julius Paulus (2d Century A.D.), it had no limitation in time (Haber- 
ling).*"* The low estate of the Roman army surgeon, and his inabihty 
to lift himself and his order out of it, is partly to be explained by the 
inadequate medical training of his time. Although the greatest Greek 
physicians of the period were residents of Rome, and many Roman 
citizens became celebrated in the profession, there was no organization 
of medical education whatever until the 3d Century A. D.; and, without 
the aid of printed books (medical manuscripts were scarce), the legionarj' 
physicians on field duty were at a sad pass in difficult cases. This 
explains the various sarcasms of contemporary Greek writers to the 
effect that the physical exercises exacted by the general were better 
for the soldier's health than the ministrations of the physicians.*^ It 
was only after the reign of Septimius Severus (193-211 A.D.) that a 
state license was required for the right to practice {medicus a repuhlica 
probatus), and Alexander Severus (222-235) was the first to have lecture 



" Haberling. pp. 59-63. 

" V. Deneffe: Chirurgie antique. Anvers, 1893, 12; 33, pi. ii. 

" Non fomenta sauciia. Tacitus, Ann. i, 65. 

" Trajanus imperator milites in proelio vulneratos curabat. Cum autera fasciae et volumina 
deCcerent, ne suae quidem vesti pepercit, eed earn totam in ligamcnta discidit. Dio Cassius, 68. 
Cited by Frolich. 

" Hsiberling, 64-65. 

" e. g. Onosander: ffTpOLTrjyiKOi '. 13-14. Cited by Haberling, p. 15. 



68 History of Military Medicine 

halls built for the teaching of medicine in Rome.^® For the advance- 
ment of military medicine, the seed thus sown was to come to best 
fruition in the Eastern Empire. 

Roman Military Hospitals 

The excavation of three Roman military hospitals, near Vienna, 
Bonn and the Swiss Baden, during 1887-1904, has revolutionized our 
knowledge of the status of hospital construction and administration in 
antiquity. We read of the ancient temples of J^sculapius (Asclepieia), 
the superstitious observances of which were ridiculed by Aristophanes, 
or of the later latreia or private wards in the houses of Greek physicians, 
or of the surgeon's operating room (as described by Hippocrates), or 
of the model room in the surgeon's house at Pompeii, but always with a 
skeptical feeling that these phases must have been rare and exceptional. 
Now we have the evidence of actual structures, which can be studied in 
the plans. 

The Roman landlords eventually acquired valetudinaria or quarters 
on their estates for sick slaves, more from a gradual perception of the 
economic advantages of keeping slaves in good condition than from any 
humanitarian or ethical motives.*^ By the 1st Century B. C, this 
arrangement had so demonstrated its worth that valetudinaria for 
wealthy free-born citizens became common and are mentioned three 
times by Seneca.^^ In course of time some of these came to be large 
and well equipped institutions. In republican Rome, the care of the 
sick and wounded soldier was based upon the theory that "some 
knowledge of medicine was expected of every Roman citizen" (Allbutt.)^^ 
After the Second Punic War, the wounded were carried by the velites 
to the rear, thence to tents or huts, where their wounds were bound, 
or else they were billeted in the houses of the wealthy, or sent to a safe- 
guarded place, sometimes by wagon transportation. ^'^ As long as 
fighting was within the Italian peninsula and near Rome, it was possible 
to shelter the wounded in private homes, or fortified places or private 
hospitals like the above, and such retreats were called by the architect 
Vitruvius '' hospiialia;'"^^ but when warfare was carried into unknown 
and distant lands, among barbaric or semi-civilized peoples, some other 
arrangement had to be made. In the book of Hyginus on the munitions 



" Haberling, pp. 65-67. 

" M. Meyer-Steineg: Jena med.-hist. Beitr., 1912, Heft., 3, 31-34. Cato the Censor (ii, 7) recom- 
mended that old and invalid slaves be sold, like worn-out oxen or utensils; unsaleable slaves wft'O 
marooned on Tiber Island to starve. 

's Meyer-Steineg, 32 

»» Allbutt: op. cii., 466. 

•»Livy. iv, 31. 

" Vitruvius: Architectura, vi, 10. Cited by Haberling. 



Rome 69 

of camps, ^^ provision is made for the location of two cohorts on either 
side of camp headquarters (praetoriinn) facing the main street, (via 
principalis); to the rear of the praetorium were the quartermaster's 
headquarters (quaestorium), and, on the right and left of this the laletu- 
dinarium or hospital for sick and wounded soldiers (valetudinarii) , 
the veterinary hospital (veterinarium) and the blacksmith shops (fahrica), 
the latter far removed, so as not to disturb the patients. ^'^ The hospital 
was controlled by the camp commander {praefedus castrorum), and, 
according to Vegetius and the Digests, the hospital personnel con- 
sisted of hospital superintendents (optiones valetudinarii), the physicians 
(ynediei castrorum), the sanitary personnel (capsarii), who carried bandag- 
ing material in a pouch (capsa) and were attended by pupils (discentes), 
the paper-work personnel (librarii) and those who waited on the sick 
(qui aegris praesto sunt).^^ The digests specify inspection of hospitals 
{valetudinarios inspicere) as the duty of the tribunes. As noted by 
Brian, the hospital physicians and inspectors are commemorated in a 
number of inscriptions. ®° 

Until the discovery of the legionary camp at Xovaesium, on the 
Roman road to Cologne, near Bonn (Lower Rhineland), by Constantin 
Koenen,^® evidence as to the existence of these military hospitals was 
merely on paper. Koenen's excavations (1887-1901J revealed, however, 
at the back of the praetorium and adjoining the quaestor's headquarters, 
the remains of a stone hospital, 90 by 50 meters in dimensions, built on 
the corridor plan, with entrances and exits so arranged as to avoid 
draughts in the wards, which opened into closed corridors and quad- 
rangles, the dining room facing the main entrance and situated between 
the two main quadrangles. The 38 sick wards, each 18.2 meters square, 
were ranged along the full length of the outer wards and inner quadrangles 
and were probably intended for 5-6 patients each. The hospital would 
therefore accommodate about 198-i-20 patients." Many surgical 
instruments and ointment boxes were found in the ruins, and the late 
Professor Haverfield found evidence of a good diet kitchen (^oysters, 
meat, eggs) in the rubbish pit.''^ The fortress of Xovaesium was origi- 
nally established by Tiberius Caesar (14-37 A.D.J but the quarters were 
rebuilt in stone by Claudius (41-54). 

In 1904, the legionary camp at Carnuntum, on the Danube, 40 km. 



"Uyginus: De munitione castrorum, Gottingen, 1848, p. 68. 

" For the arraagemenl of a Roman c8Lmp, with plan, see, Haberling: Die Militarlazarette im alten 
Rom Deutsche mil.-arztl. Zlschr., Berl., 1909, xxxviii, 445. 
" Ilaberling, op. cit., 458-465. 

" R, Rriau: Le service de sante mLlitaire chez les Remains. Paris, 1866, 24-41. 
" C. Kocnen; Beschreibung von Novaesium. Bonn. Jahrb., 111-112, pp. 180-182. 
'■ Haberiing, 448-452, with plan. Meyer-Steineg: op. cit., 42-44. 
«^ Mlbutt 488. 



70 History of Military Medicine 

from Vienna, was discovered by Col. von Groller,®' and in the statutory 
position behind the praetorium there were found remains of the original 
quadrangular camp hospital (1st century A.D.), 47.4 by 34.2 meters 
in dimensions, and an enlarged hospital of later date, covering 5,890 
square meters, of which no less than 1,800 were devoted to an open 
central court. ^° 

Both hospitals had the same arrangement of wards, opening upon 
corridors (parallel with the longer walls) and the central quadrangle. 
It is possible that the quadrangle, like the patio in a Spanish house, 
was a flower garden. There were wards on both sides of the 
corridors, and remains of sewers, water-piping, a heating plant, kitchen 
and apothecary's shop have been found. While only two surgical 
instruments were excavated, an inscription on the altar of the ward 
attendants (capsarii) indicates the true character of the building.''^ 

In 1892-6, the imposing walls of a large structure at Baden (Switzer- 
land), some distance from the old Roman camp at Vindonissa (Windisch), 
were excavated, the coins found being of the time of Claudius Caesar, 
and the large find of surgical instruments indicating a medical estab- 
lishment. As Baden is described in Tacitus as a much frequented health 
resort and mineral spring,^^ Haberling assumes that this building was 
either a convalescent hospital or a supply depot, since it differs in plan 
from the hospitals at Carnuntum and Novaesium.^^ That many similar 
hospitals were put up for such large armies as the Romans maintained in 
Germany is highly probable. 

Roman Military Sanitation 

The Romans left no treatises on military sanitation, but they were 
an instinctively clean people, and their concern for purity of food and 
water and for the disposal of sewage and excreta were not without their 
effect upon the hygiene of armies. Caesar, like Xenophon, paid great 
heed to rations and to the pitching of his camp upon a height at the 
head of a river, near wood and water. To camp in a valley was a bar- 
baric custom {consuetudo barbarorum). The architect Vitruvius and 
the agriculturist Columella, both of the 1st Century A. D., had an intui- 
tive feeling that marshes engender minute living creatures which might 
cause pestilential fevers. Vitruvius says: 

The vicinity of a marsh is to be avoided, because, when the morning airs reach 
the house at sunrise, the mists of these places arrive with them, and the wind, mixed 



•' von GroUer: Der romische Limes in Oesterreich, Wien, 1906. 

" For plans of Carnuntum, see Haberling, 453; 455. Meyer-Steineg, 36. 

" Haberling, 452-458. Meyer-Steineg, 35-42. 

" "Locus, amoeno salubrium aquarum usu frequens." Tacitus: Ilisloria. i, 67. 

" Haberling, 458. 



Rome 71 

with these vapors, spreads the poisonous exhalations of the creatures inhabiting the 
marsh, and so make the place pestilential. (I, 4.) 

Columella says: 

Nor should buildings be erected near a marsh nor a military road adjoin it, 
because through heat it gives forth noxious poisons and engenders animals around 
with dangerous stings, which fly at us in dense swarms. (I, 5.) 

The mosquito net or canopy (conopeum) is ridiculed by Horace 
(Epodes, IX, 16) Juvenal (VI, 80) and Propertius (III, 11,45). Vitruvius' 
treatise on architecture contains a careful survey of the diseases caused by 
bad water supply and exposure to the elements; recommends massive in- 
gestion of water in constipation and calculus; the use of warm baths in 
gout, paralysis and the neuroses; and treats informingly of the quality of 
the air, climate, acclimatization, water-supply, filtration of water, mineral 
springs, the soil as a site for building, the hygiene and lighting of habita- 
tions and other buildings, the planning of to'wms and their water-supply.'^* 
That this view of architecture as a branch of sanitation (Lord Kelvin's 
view) was no mere sterile theory is evident from the actual remains of the 
spacious public buildings and military hospitals and the gigantic sewer- 
courses. The Roman scheme of physical training was not, as with the 
Greeks, a joyous, spontaneous plein air cult, but had the same rigorous 
practical tendency, and was concentrated on infantry and cavalry drill 
and tactics, held twice daily in the case of recruits, with such exercises 
as jumping, swimming, fencing, archery and equitation.''* The gladia- 
torial shows, as Lecky maintains, were designed to harden the people to 
the bloody and brutal aspects of warfare as a primary function of the 
Roman state.'® The most memorable picture of the Roman army as 
a mechanism of precision, in its most efficient period, comes from an 
unexpected source, namely, the Jewish historian Flavins Josephus 
(born 37 A. D.), who, originally a priest, had himself seen military 
service under Vespasian, and wrote as eye-witness: 

Now here one cannot but admire at the precaution of the Romans, in providing 
themselves of such household servants, as might not only serve at other times for 
the common offices of life, but might also be of advantage to them in their wars. 
And, indeed, if any one does but attend to the other parts of their military discipline, 
he will be forced to confess, that their obtaining so large a dominion hath been the 
acquisition of their valour, and not the bare gift of fortune; for they do not begin 
to use their weapons first in time of war, nor do they then put their hands first into 
motion, while they avoided so to do in times of peace; but as if their weapons did 
always cling to them, they have never any truce from warlike exercises; nor do they 
stay till times of war admonish them to use them; for their military exercises differ 



"A. SoIIner: Die hygienischen Anscliauungen des romischen Architekten VitruTius. Jena med. 
hist. Beitr., 1913, Heft 4. 1-64. 

■'J. Mnrquardt & Th. Mommsen: Handbuch der romischen Allerthiimer. Leipz., 1884, V. 567 
'» W. E. II. Lecky: History of European Morals. 



72 History of Military Medicine 

not at all from the real use of their arms, but every soldier is every day exercised, 
and that with real diligence, as if it were in time of war, which is the reason why they 
bear the fatigue of battles so easily; for neither can any disorder remove them from 
their usual regularity, nor can fear affright them out of it, nor can labor tire them; 
which firmness of conduct makes tTiem always to overcome those that have not the 
same firmness; nor would he be mistaken that should call those their exercises 
unbloody battles, and their battles bloody exercises. Nor can their enemies easily 
surprise them with the suddenness of their incursions; for as soon as they have 
marched into an enemy's land, they do not begin to fight till they have walled their 
camp about; nor is the fence they raise rashly made, or uneven; nor do they all 
abide in it, nor do those that are in it take their places at random; but if it happens 
that the ground is uneven, it is first levelled; their camp is also four square by measure, 
and carpenters are ready with their tools to erect their buildings for them. 

As for what is within the camp, it is set apart for tents, but the outward circum- 
ference hath the resemblance to a wall, and is adorned with towers at equal distances, 
where between the towers stand the engines for throwing arrows and darts, and for 
slinging stones, and where they lay all other engines that can annoy the enemy, all 
ready for their several operations. They also erect four gates, one at every side of 
the circumference, and those large enough for the entrance of the beasts, and wide 
enough for making excursions, if occasion should require. They divide the camp 
within into streets very conveniently, and place the tents of the commanders in the 
middle, but in the very midst of all is the general's own tent, in the nature of a temple, 
insomuch that it appears to be a city built on the sudden; with its market-place, 
and place for handicraft trades, and with seats for the officers, superior and inferior, 
where if any differences arise, their causes are heard and determined. The camp, 
and all that is in it, is encompassed with a wall round about, and that sooner than one 
would imagine, and this by the multitude and the skill of the laborers; and if occasion 
require, a trench is drawn round the whole, whose depth is four cubits, and its breadth 
equal. 

When they have thus secured themselves, they live together by companies, 
with quietness and decency, as are all their other affairs managed with good order 
and security. Each company hath also their wood, and their corn, and their water 
brought them, when they stand in need of them; for they neither sup nor dine as 
they please themselves singlj', but all together. Their times also for sleeping and 
watching, and rising, are notified beforehand by the sound of trumpets, nor is any- 
thing done without such a signal; and in the morning the soldiery go every one to 
their centurions, and these centurions to their tribunes, to salute them; with whom 
all the superior officers go to the general of the whole army, who then gives them 
of course the watchword and other orders, to be by them carried to all that are 
under their command; which is also observed when they go to fight, and thereby 
they turn themselves about on the sudden when there is occasion for making sallies, 
as they come back when they are recalled in crowds also. 

Now when they are to go out of their camp, the trumpet gives a sound, at which 
time nobody lies still, but at the first intimation they take down their tents, and all 
is made ready for their going out; then do the trumpets sound again, to order them to 
get ready for the march; then do they lay their baggage suddenly upon their mules, 
and other beasts of burthen, and stand, as at the place of starting, ready to march; 
when also they set fire to their camp, and this they do because it will be easy for them 
to erect another camp, and that it may not ever be of use to their enemies. Then do 
the trumpets give a sound the third time, that they are to go out, in order to excite 
those that on any account are a little tardy, that so no one may be out of his rank 



Rome 73 

when the army marches. Then does the crier stand at the general's right hand, and 
asks them thrice in their own tongue, whether they be now ready to go out to war 
or not? To which they reply as often, with a loud and cheerful voice, saying. We 
are ready. And this they do almost before the question is asked them: they do 
this as filled with a kind of martial fury, and at the same time that they cry out, they 
lift up their right hands also. 

When after this, they are gone out of their camp, they all march without noise, 
and in a decent manner, and every one keeps his own rank, as if they were going to 
war. The footmen are armed with breastplates and headpieces and have swords on 
each side, but the sword which is upon their left side is much longer than the other, 
for that on the right side is not longer than a span. Those infantrymen also that 
are chosen out from the rest to be about the general himself, have a lance and a 
buckler, but the rest of the infantry have a spear, and a long buckler, besides a saw 
and a basket, a pickaxe, and an axe, a thong of leather, and a hook, with provisions 
for three days, so that an infantryman hath no great need of a mule to carry his 
burdens. The cavalry have a long sword on their right sides, and a long pole in 
their hand; a shield also lies by them obliquely on one side of their horses with three 
or more darts that are borne in their quiver, having broad points, and not smaller 
than spears. They have also headpieces, and breastplates, in like manner as have 
all the infantry. And for those that are chosen to be about the general, their armor 
no way differs from that of the horsemen belonging to other troops; and he always 
leads the legions forth to whom the lot assigns that employment. 

This is the manner of the marching and resting of the Romans, as also these are 
the several sorts of weapons they use. But when they are to fight, they leave noth- 
ing without forecast, nor to be done off hand, but counsel is ever first taken before 
any work is begun and what hath been there resolved upon is put in execution 
presently; for which reason they seldom commit any errors, and if they have been 
mistaken at any time, they easily correct those mistakes. They also esteem any 
errors they commit upon taking counsel beforehand, to be better than such rash 
success as is owing to fortune only; because such a fortuitous advantage tempts them 
to be inconsiderate, while consultation, though it may sometimes fail of success, 
hath this good in it, that it makes men more careful hereafter; but for the advantages 
that arise from chance, they are not owing to him that gains them; and as to what 
melancholy accidents happen unexpectedly, there is this comfort in them, that they 
had however taken the best consultations they could to prevent them. 

Now they so manage their preparatory exercises of their weapons, that not the 
bodies of the soldiers only, but their souls, may also become stronger; they are 
moreover hardened for war by fear, for their laws inflict capital punishments, not 
only for soldiers running away from their ranks, but for slothfulness and inactivity, 
though it be but in a lesser degree; as are their generals more severe than their laws, 
for they prevent any imputation of cruelty toward those under condemnation, by 
the great rewards they bestow on the valiant soldiers; and the readiness of obeying 
their commanders is so great, that it is very ornamental in peace; but when they come 
to a battle, the whole army is but one body, so well coupled together are their ranks, 
so sudden are their turnings about, so sharp their hearing, as to what orders are 
given them, so quick their sight of the ensigns, and so nimble are their hands when 
they set to work, whereby it comes to pass, that what they do is done quickly, and 
what they suffer they bear with the greatest patience. Nor can we find any examples 
where they have been conquered in battle, when they came to a close fight, either by 
the multitude of the enemies, or by their stratagems, or by the difficulties in the 
places they were in, no, nor by fortune neither, for their victories have been surer to 



74 History of Military Medicine 

them than fortune could have granted them. In a case, therefore, where counsel 
still goes before action, and where, after taking the best advice, that advice is followed 
by so active an army, what wonder is it that Euphrates on the east, the ocean on the 
west, the most fertile regions of Libya on the south, and the Danube and the Rhine 
on the north, are the limits of this empire? One might well say, that the Roman 
possessions are not inferior to the Romans themselves.'^ 

Public Works Performed by the Roman Army 
Until very recent years, little has been known of the streets, side- 
walks, gutters, sewers, drains, cesspools, public fountains and water- 
courses of the great cities of antiquity. 

The wide well-paved streets and sidewalks, the sewers and stone privies found by 
Place at Khorsabad (7^0 B. C), the gigantic drains and sewers of Babylon, a city 
twice the size of London, the model arrangements of streets and sanitary features of 
Priene (Greece) and Pompeii (Rome) have been the admiration of all visitors at 
museums and sanitary expositions, and in these matters Rome yielded to none. 
The rules for the construction of its streets were writ large in the Laws of the 
Twelve Tables. Macadamized embankments with sidewalks were introduced by 
Appius Claudius (312 B. C). The general paving of streets in the city and macada- 
mizing of roads was pushed with remarkable energy in 174 and street-cleaning under 
four aediles was established by the lex municipalis Julia of Caesar (45 B. C). The 
Cloaca maxima, frequently clogged with refuse but always cleaned again with Roman 
energy, eventually disposed of the entire sewage, and by 315 A. D., there were 144 
public latrines and 116 necessariae along the Aurelian Wall.''* A similar arrange- 
ment has been found in the Roman military station at Timgad in the Sahara (Boissier)." 
The manner in which these public works were carried out all over the vast empire is 
germane to our subject. 

The ruling principle of the Roman army was that no man should 
be kept idle. Discipline was the strictest conceivable. Desertion, 
cowardice in battle and insubordination were punishable by death, 
executed either by soldiery or the imperial lictors; whole commands 
were decimated by drawing lots and deserters to the enemy were thrown 
to wild beasts. *'' Under this harsh regime, the whole army was utilized 
in time of peace for the construction of public works, and it is of record 
that the walls and fortifications on the boundary of the empire and in 
Britain, the many military roads, all forts, barracks and military hos- 
pitals, many temples and public buildings, as well as canals, bridges, 
sewers and water-courses were constructed by Roman soldiery, under 
the direction of technicians. Mining, as well as the dredging of harbors 
and the drainage of swamps were also part of this duty, in fact, the 
general sanitation of the empire was largely the work of the army.^^ 



" Josephus: Bellum Judaicum, iii, 5. Translation of William Whiston. 

"H. A. Nielsen: Die Strassenhygiene im Altertume. Arch. f. Hyg., MiJnchen & Berlin, 1902, 
xlui, 85-115. 

" G. Boissier: L'Afrique romaine, Paris, 1893. F. W. Hall, Timgad, The Pompeii of Algeria 
Discovery, Lond., 1921, ii, 292. 

" Nfarquardt & Mommsen: op. cil., p. 571-573. 

81 Marquardt & Mommsen: op. cil.. 568-571 



Rome 75 

How an empire so wonderfully organized could have fallen has 
exercised some of the best wits since Gibbon's time. Gibbon wrote 
the Decline and Fall to prove that the growth of Christianity was the 
efficient cause, but his famous sarcasm about the early Christians, 
that "their aversion to an active life contributed rather to excuse them 
from the service than to exclude them from the honors of the state and 
the army"*2 has long since gone up in smoke. The forward-looking 
emperors, beginning with Augustus Caesar, appear to have recognized 
that an empire so constituted as the Roman could not run forever, 
and relied mainly upon the Army to keep things going. Such a mechan- 
ism was, in fact, like a clock wound up to run a certain length of time 
and predestined to run down after a definite interval. That the empire 
should have lasted full 500 years, that Roman history covers 1,200 
years, is the surprising thing. Very interesting it is to read in Suetonius 
of the keen desire of Augustus that the ancient traditions of republican 
Rome should be maintained, of his private consultations with the magis- 
trates, the Senate and Tiberius as to the condition and future chances 
of the empire, of his long period of mourning for the lost legions of 
Varus, destroyed in the German wars;^^ and while most of the emperors 
from Augustus down were of the "sexual-intellectual" type so dangerous 
to modern states,^* the best of them were exemplars of that union of 
.strength and sagacitj', of firmness and mildness, which made the name of 
Rome everywhere respected. Of the ultimate decadence of manners and 
morals the third satire of Juvenal tells more than enough. Wells 
scores a number of strong points: the childlike delight in cruelty, as if 
"the misshapen hairy paw" of Neanderthal man were thrust at us 
by a morning caller; the mental infantilism which cultivated augury, 
ignored geography and snubbed science and medicine; the "rich man's 
culture" of the imperial city which was only veneer; the consequent 
apathy of the population to the vices of the Caesars and the invasion of 
the barbarians; the steady depopulation of the empire,** all which had 
more to do with the dissolution of the mercenary army than the attitude 
of the early Christians. The Roman nobles of the decline did not even 
trust the barbarians they had hired to guard their frontiers. The 



'- Gibbon: Decline and Fall of the Roman Empire, ch. xv. 

"Suetonius: Divus Augustus, 23-25, 28, 31, 35-40, 73, 98. 

*• The most striking; example is Tiberius, the tiger cat on the throne, who used the lei de majeslatr 
to destroy many of the best of the Roman aristocracy and whose senile vices at Capri are untranslatable. 
A youth of sensible character and behavior, Tiberius lived to see his own mother taken from his 
father by Augustus and was later required to divorce his wife, to whom he was deeply attached, in 
order to marry the same emperor's dissolute daughter. Brooding over these tyrannies undoubtedly 
did much to produce the cryptic mind which made no man's life safe while Tiberius reigned. The 
splendid head, of the busts in the \ai)Ies Museum, tells of his vast administrative abilities; the eyes, 
even in the cold stone, are those of a wild animal. 

«• Wells: Outline of History, ch. xxvi-xxviii. 



76 History of Military Medicine 

execution of Stilicho at Ravenna gave Alaric his opportunity; what fol- 
lowed was but a foregone conclusion. But even as the Greek civilization 
is our best intellectual heritage, so republican Rome has been the world's 
great school for the development of manly character, of the centric 
idea that virtue derives from vir, a man. In the words of Thoreau: 

The fact that the Romans once inhabited her reflects no little dignity on Nature 
herself; that from some particular hill the Romans looked out on the sea. She need 
not be ashamed of her children. 



CHAPTER IV 

The Middle Ages 

Modern science properly begins with the work of Copernicus 
and Vesalius (1543), but in the social history of Europe, the Middle 
Ages comprise the period between the downfall of the ^Yestern and 
the Eastern Roman Empires (476-1453 A. D.). During this long 
interperiod of nearly a thousand years, printing, firearms and the 
mariner's compass were invented, but science sank to a comparatively 
low level, and while there was a remarkable upward trend in the thir- 
teenth century and much was eventually accomplished in military 
surgery and preventive medicine, anatomy, physiology and pathology 
were almost non-existent and internal medicine sank into what Allbutt 
styles "unexampled and even odious degradation." The reason for all 
this is not far to seek. Even before the downfall of the Western Roman 
Empire, Greek science had died out utterly, Greek philosophy had 
proved a total failure, and with the downfall of Rome, Europe became 
practically nationless, her peoples continually at the mercy of fierce 
wandering tribes of barbarians and reduced to the apathetic condition 
described in Shakespeare's line 

"The indifferent children of the earth." 

The successive blows dealt by Ostrogoth and Visigoth, Vandal, 
Hun and Lombard might be described as an effective macing of the 
human intellect, destroying all ambition, all initiative and almost 
all productive power. While the Orient maintained her commerce 
and her culture. Western Europe was reduced to a peasant status in 
respect of agriculture, commerce, finance, education and means of 
seK-defense. It was a period in which everything had to be begun 
again, in which the older edifice of science was slowly scrapped, to be 
rebuilt from the ground up. What saved European civilization from 
utter destruction was the previous Latinization of the West by the 
Roman power, the conversion of the barbarians to Christianity, the 
upbuilding of new nations through the failure of the Feudal System, 
and the preservation of the literary remains of antiquity by Byzantium, 
Islam and the monks of the Roman Church. The growth of Chris- 
tianity exerted a refining influence upon morals and a softening efi"ect 
upon manners, and through these influences the Germanic and Norman 
conquerors were, in a manner, Latinized. In the long run Pope and 
Emperor did much for medicine through the founding of universities, 

77 



78 History of Military Medicine 

the enactment of laws regulating medical practice, the development 
of hospitals and the organization of sick nursing. For science, however, 
the period was one of long, tedious gestation, aptly described by Singer 
as "the embryology of modern thought," and during the 12th century, 
medicine was dominated by "the heavy hand of the Arabian" (Osier). 

Byzantium 

The Western Roman Empire lasted 500 years. The Eastern 
Empire lasted nearly a thousand years (395-1453). This was accom- 
plished by the maintenance of an ironclad military despotism and 
bureaucracy and through the fact that the whole Eastern Empire 
was eventually encysted, as in a "calcareous shell, "^ within the ramparts 
of Constantinople. The effect of this imposition of Roman adminis- 
trative machinery upon a population ultimately Greek in cast was to 
keep science stationary until it finally went into retrogression. Byzan- 
tium was thus a kind of cold storage plant for the remains of Greek 
culture, or, as Allbutt puts it: "The chief monuments of learning were 
stored in Byzantium until Western Europe was fit to take care of 
them."^ Byzantium, therefore, had no mediaeval period but led an 
independent, stationary existence all its own, marking time in the past. 
The traditions of Roman law and military science were rigorously 
maintained, and this civilization maintained a higher general level than 
that of any other European state during the Middle Ages. Its history 
is a monotonous record of 

Half-emperors and quarter-emperors, 
Each with his bay-leaf fillet, loose-thonged vest, 
Loric and low-browed Gorgon on the breast, . . . 
Born in the porphyry chamber at Byzant.' 

But in the history of military medicine the Eastern Empire becomes 
of singular importance. Long before the fall of Rome the military 
system of the Western Empire had gone to seed, its proud legions 
split up into small detachments of mercenary barbarians and confined 
to the provinces of Italy. The name "legion" last appears in the 
Noiitia digniiatum of the city of Constantinople (395-407) and dis- 
appears after the time of Justinian. The names of Roman army 
surgeons have already disappeared from the carved inscriptions by 
250 A. D.^ A century later the absolute lack of proper arrangements 



1 AUbutt: Glasgow, M.J., 1913, 4. s., Ixxx, 323. 

' AUbutt: Science aod Mediaeval Thought. London, 1901, 65. 

' Robert Browning: Protus. 

♦ Haberling: Verofifentl. a. d. Geb. d. Mil.-San.-Weaens. Berlin, 1910, Heft. 42, 67-71. 



Middle Ages 79 

for care of the wounded in a battle fought by JuHan and Constans 
against the Chionites is lamented by Ammianus Marcellinus.* In 
Byzantium, however, after the reign of Justinian (527-565), we find a 
typically modern army, organized in brigades and divisions, with field 
forces of disciplined regulars (financed by scutage), a complete terri- 
torial sj'stem of recruiting (5,000 men from each military district), 
with frontier militia, supply depots and trains, engineers, medical corps, 
and such organization and training as were not to be found in the 
West until during the 16th-17th centuries.® That the medical personnel 
was adequate is indicated by the anecdote of the historian Procopius 
(a field commander under Belisarius), in which the life of Arses is 
saved, after a consultation, by the clever surgery of "one of the phy- 
sicians" {tuv tls laTpbv)J In his treatise on strategy^ the Emperor 
Mauritius (582-602) introduced a kind of sanitary formation for his 
cavalry, consisting of 8-18 unarmed deputati^ assigned to every detach- 
ment ifiavbov) of 200 to 400 men, in addition to physicians (laTpoi). 
This sanitary personnel, later called scribones,^'^ followed the fighting 
columns at a distance of 200 feet in order to bring the severely wounded 
out of danger during an engagement. To this end the saddles of 
their horses had two ladder-stirrups on the left side, and flasks of water 
were carried to revive the faint. The bearers received a piece of gold 
for every wounded soldier rescued, and as they collected the arms of 
the wounded and of the survivors after a battle (to prevent plunder- 
ing), they came in for a share of the booty." The same organization is 
again described, 300 years later, in the Tactics of Emperor Leo (886- 
912),^^ showing the rigidity of Byzantine military administration. 



' Frolich: Arch. f. klin. Chir., Berl., 1880, xxv, 311. Frolich translates this passage as follows: 
" Each side looked after its wounded as best it could and according to the number of attendants (cur- 
antes); some, severely wounded, and bleeding to death, reluctantly breathed their last; others, trans- 
fixed by spears and fallen to the ground, were cast aside, as if corpses; others had so many wounds 
that it was forbidden to do anything for them, that these suffering ones should not be further tormented 
by useless manhandling; many, on account of the uncertain issue in the withdrawal of weapons from 
wounds, suffered agony worse than death." Ammianus Marcellinus: Rerum Gestarum, xix, 215. 
Haberling cites further the case of Emperor Valentinian, who, sustaining a hemorrhage on the Danube 
(325 A. D.), could not obtain a physician to do venesection, because all his army surgeons were engaged 
in combating an epidemic in camp. 

'Capt. C. F. Atkinson: Encyclop. Britann., 11th ed., Cambridge, 1910, ii, 596. 

' Procopius: De hello Gothico, ii, 2 (Teubner, 157-158). Cited by Haberling, op. cit., p. 69. 

' Mauritius: Ars militaris, ii, 8. Cited by Kiibn and Frolich. 

• According to Kiihn, the reading is either btOTTOTCLTOS , drink-giver, or biTtOTOLTOS (deputalus) , 
one deputized or assigned to a particular task. Both readings, Kiihn says, are employed in the 
Tactics of Leo. 

'" (TKpi^OViS 's construed by Frolich as the equivalent of the mililes haslati of the later Latin 
writers, i. e., those who guarded the person of the general and were often sent by the emperor on 
commissions in the distant provinces., Kiihn. Program vii, Leipsig, 1826, 7. footnote 1. 

II Frolich, 313-314. 

'2 Leonis imperatoris Tactica, iv, 15; xvi, 51; 53; 119. Cited by Kiihn and Frolich. 



80 History of AIilitary Medicine 

The army surgeons are classed by Leo as non-combatants (ajuaxot), 
the litter-bearers (deputati) are chosen from the weaker elements in 
the command, and the old arrangements about ladder-stirrups and 
water-flasks are maintained. In the Tactics of Constantine VII 
Porphyrogenitus (911-959)^^ the selfsame organization is monotonously 
preserved. The Tactics of Emperor Leo, regarded as the best of all 
the Byzantine treatises on military science, contains at the end an 
impressive passage on the absolute necessity of medical personnel to 
armies, and the following charge to the commanding general on the care 
of the wounded : 

Give all the care you possibly can to your wounded, for if you neglect them, you 
will make your soldiers timorous and cowardly before a battle, and, not only that, 
but your personnel, whom you might preserve and retain by proper consideration for 
their health and welfare, will be otherwise lost to you through your own negligence." 

On the score of military hygiene, Bj'zantine practice was probably 
based upon the precepts in the treatise on military science of Vegetius," 
who lived in the reign of Valentinian II (375-392 A. D.). 

Vegetius maintains that large bodies of troops should not camp too long in any 
one place, since epidemic diseases arise from corruption of the air and water and 
can only be prevented by frequent change of camp. Troops should not camp upon 
dry hillsides, devoid of shade, and, in summer, should always be provided with tents. 
One drink of polluted water may be "as potent as poison" in starting an epidemic 
Daily exercises, in the opinion of experienced commanders, are better for the health 
of soldiery than physicians. In periods of great heat all marching should be done 
before sunrise. In winter little can be expected of the soldier if he is allowed to 
freeze. There should be no lack of fuel and clothing. Hunger is more cruel than 
the sword. Recruits from cold climates are hardier and more resistant to disease 
than those from warmer climes; and the army must be continually strengthened by 
recruits from the farmlands, who are stronger than the city-bred. The recruit 
should be young, but strength is more essential than size; he should be keen-eyed, 
with head erect, broad chest, long muscular arms, capable hands, slender flanks, with 
thighs, calves, and feet not distended by superfluous flesh but hard-with accumulated 
muscle. It is best to discharge the unfit at once. It is the duty of commanding 
officers to provide good water, proper food and medical attention for the sick. The 
camp commander should look after the patients in their tents, the physicians who 
attend them and the expenses incident thereto. 

In Byzantium some provision appears to have been made for 
asylums for disabled soldiers, e. g., the perhaps mythical retreat said 

" Constantine: jStjSXtOJ' rd/Crtpoi' (ed. Meursius, 1617. p. 1280). Cited by Kiihn and Frolich. 
In closing references from the Greek and Latin writers it may be repeated that aJl the important biblio- 
graphical references to military medicine in classical antiquity were first given by C. G Kiihn in the 
academic programs pubished by him at Leipzig in 1824r-27. Had these Latin dissertations been trans- 
lated into a modern language, much labor might have been saved to all subsequent investigators and 
Kiihn would have been credited with his actual performance, viz., the first and, in its time, the most 
exhaustive investigation of the whole subject before Briau and Frolich. 

"Leo: Tactica. Epilogue (Leyden, 1612, p. 381). Cited by Ilaberling, p. 70. 

i» Vegetius: De re militari, iii, 2. Cited and translated by Frolich, op. cil., 311-312. 



Middle Ages 81 

to have been founded by Zotikos at the instance of Constant! ne (306- 
337), the Lobotropheion of Justin II (565-578) for crippled soldiers, 
and the Orphanotropheion of Alexis Conmenus I (1081-1118) for sick 
and invalided soldiers. ^^ 

The medical texts of the Byzantine period are, in the main, compila- 
tions, but the principal writers, Oribasius, Aetius and Paul, have pre- 
served in their texts much of earlier Greek medicine that might otherwise 
have been lost. Aetius describes tonsillotomy, urethrotomy, operative 
treatment of hsemorrhoids and ligation of the brachial artery above the 
sac for aneurism. Alexander of Tralles (525-605) first recommended 
colchicum for gout, perhaps the most common malady at the Byzantine 
court. -^^ The sixth book of the Epitome of Paul of ^Egina (6'-25-690) 
is the best treatise on surgery in its period and was the standard source 
of authority up to the twelfth century. The chapter on military sur- 
gery (VI, 88) has been Englished by Francis Adams in his translation 
of Paul (Sydenham Society, ii, 418-4'-2-2). Like that in Celsus it deals 
with the extraction of spear and arrow points, and was copied later by 
all the Arabian physicians. 

The different kinds of weapons are minutely described, and while the general 
directions for extraction follow the lines laid down by Celsus, more than half of Paul's 
chapter contains new material, on the extraction of missiles from the different organs 
and viscera and on the treatment of wounds from the poisoned arrows used by 
the Dacians and Dalmatians to destroy wild animals. He points out that extensive 
suppuration of viscera like the liver, omentum, peritoneum and uterus, may not 
necessarily be fatal; describes the characteristic symptoms of wounds of the brain 
and its membranes, and of the chest, lungs, heart, diaphragm, abdominal viscera 
and bladder in an entirely modern manner, Mith good practical directions for removal 
of the missile from these parts. He recommends tracheotomy in angina, trephining 
in wounds of the brain, and ligation on both sides in wounds of the arteries. 

In wounds of important viscera, with fatal sjTnptoms, and where 
extraction would lacerate delicate tissues, Paul recommends that "we 
dechne the attempt, lest while we do no good we expose ourselves to the 
reprobation of ignorant people. But if the result be dubious, we must 
make the attempt, having first given warning of the danger." For 
reasons which will appear, this rule became the guiding principle of 
all surgeons up to the 16th century. 



" K. Sudhoff: Jahresk, f. arzU. Fortbild., Munchen, 1917, viii, 46. In the ancient Greek cities 
the adi'l^CLTOl, or permanently disabled war inralides, were given a small daily pension, increased 
to large sums by .Vlexander the Great in his Indian campaigns. In Rome, sepEirate colonies for intalides 
were set apart, e. g., at Italica in Spain by Scipio .\fricanus, at Nicopolis in Asia Minor by Pompey, 
and also in Egypt (Sudhoff: op. cit., 45). In the Codex of Theodosius (379-395 A. D.), veterans and 
invalides could hold lands without taxes and were provided with seed, fruits, cattle and money to run 
their farms. For the Latin text and commentary, see Sudhoff: Mitt. z. Gesch. d. Med., Leipz., 1917, 
ivi, 431-433. 

"See E. Jeanselme: La goutte S Byzance. Bull. Soc. franc, d'hist. de mM., Paris, 1920, xiv, 
137-164. 



82 History of Military Medicine 

Islam 
(732-1096) 

The Mohammedan power converted the straggling desert clans into 
military and social units, capable of acting as nations, and, once it had 
established itself, proved highly favorable to the arts and sciences. 
The Saracens preserved the remnants of Greek culture, were pioneers 
in chemistry and geology, had a most extensive pharmacopoeia, built 
great hospitals and numbered some of the greatest physicians of the 
time. What little we know of their military medicine is contained in 
the writings of these men, for there is no mention of the subject in the 
Arabian Nights. 

Of the ph^'sicians of the Eastern or Bagdad Caliphate (750-1258), 
the clinician Rhazes (860-932), famed for his original account of small- 
pox and measles, gives in his Almansor (XIII, 6), a number of sensible 
precepts on military hygiene: 

Camps should be pitched in summer on hills and high places, tents being directed 
towards the north wind, with plenty of air-space between tents. Animals should 
be kept as far from the tents as possible. In winter camps should be placed in 
low-lying places, preferably at the foot of hills or mountains, tents being directed 
towards the east and south, alternate pairs of tents being joined together. When 
moist south winds blow, rations should be cut down, wine should be interdicted and 
more military exercises taken. When the air is dry, just the opposite regime should 
be enforced. Sick cattle should be kept far from the camp, in low windless places. 
Dangerous living animals about the camp should be driven away or smoked out of 
their holes and destroyed. Poisonous, odorous plants and trees should be burned or 
the camp site should be above them. Food and drink, as causing many diseases, 
should be inspected with great caution.*^ 

The same work contains (xxv, 7) a chapter on the extraction of spear- 
points and darts, which adds nothing new to what is already given by 
Celsus and Paul. The same thing is true of the chapter on military 
surgery (IV, 4 fen. II, 10) in the Canon of Avicenna (980-1036), '^ 
otherwise one of the greatest of physicians, the founder of geology, who 
described anthrax and who practised the Hippocratic method of treating 
spinal deformities by forcible reduction. 

In the Western or Cordovan Caliphate (655-1236) flourished 
Albucasis (eleventh century), greatest of the Arabian surgeons, whose 
treatise became the standard authority after Paul. The Altasrif of 
Albucasis contains (X, 84-85, 94) chapters on the treatment of thoracic 
and visceral wounds and the extraction of arrows, which follow the 
lines laid down by Paul, particularly in semeiology, and are interesting 



" Translated by Frdlich in Arch. f. klin. Chir. Berl., 1882-83, xxviii, 864. 
"See Frolich: Arch. f. Klin. Chir. Berl.. 1884, ixx. 745-752. 



AIiDDLE Ages 83 

as containing pictures of the surgical instruments employed and several 
clinical cases. ^'^ 

The Feudal System 
On Christmas Day, 800 A. D., Charlemagne was crowned in St. 
Peter's and the Holy Roman Empire came into being. When this vast 
empire was partitioned after his death (814), feudalism gained its 
ascendancy. Although Charlemagne's own army was a strong organiza- 
tion of veterans, with supply trains, financed upon the democratic 
principle that every 3-4 men in the kingdom should maintain one of 
themselves as a soldier,^^ feudal armies were levied upon a territorial 
basis, on the theory that the king received his lands from God and 
parcelled them out to his vassals in return for 1-3 months' military 
service per annum, rendered when occasion required. This arrangement 
was carried down to the serfs or villeins, who tilled the soil. Mag- 
nificent in theory, the effect of feudalism in practice was toward extreme 
individualism and decentralization. Each powerful vassal became a 
little monarch in his own right, often at odds with his sovereign, and 
military operations of moment were carried forward with difficulty. 
Raids and assaults by mailed cavalry were the principal mode of offen- 
sive, the infantry-, made up of undisciplined peasantry, went into decline,-^ 
and chivalry and knight-errantry being individualistic and aristocratic, 
led to lawlessness and operated fatally against true military discipline. 
The effect of this order of things upon military medicine was in every 
way pernicious. The few capable physicians and surgeons of the 
time were attached to the persons of kings, popes, nobles, princes of 
the church, and other mediaeval overlords, and accompanied military 
leaders on their campaigns, but nothing whatever was done for the 
health and well being of the individual soldier. Body-physicians of 
great personages were richly rewarded for their services, but the surgical 
treatment of the common people was in the hands of wandering incisors, 
barber-surgeons and quacks of outcast status. There was no organiza- 
tion for the relief of the wounded, and as late as the sixteenth century 
Montluc declared that the best thing that could happen to a fighting 
man in battle was to be killed outright by a good arquebusade.-^ In 
a disorganized state of societ}', in which every strong overlord might 
be against his master or his fellows, surgical practice, even in the best 
hands, was sometimes bungling, came to be interdicted by the Church 



2° For the military surgery of Albucasis, see the account by Francis Adams in his Paulus ^gineta, 
Sydenham Society, London, 1846, ii, 424-425; and Frolich: Arch. f. kJin. Chir., Berl., 1884, xxx, 
364-376. 

" Atkinson: op. cit , 596. 

« Atkinson, 596-597. 

*• Cited by L. Thomas: Lectures sur I'histoire de la m^decine, Paris, 1885, 17. 



84 History of Military Medicine 

{Ecclesia abhorret a sanguine), and was despised and feared by the 
nobles as well as the people. The mediaeval epics and romances of 
chivalry describe the agony of uncertainty, even upon the withdrawal of 
a spear from a wound, as worse than death itself. The greatest surgeons 
of the time advised their professional brethren not to undertake a major 
operation upon a great person without a definite guarantee of their 
personal safety, since they were liable to torture, mutilation or murder^ 
in the event of a fatal issue. Operations like lithotomy, couching for 
cataract, and radical cure of hernia passed into the hands of outcast 
or barber-surgeons, and from tliis class came eventually such remarkable 
men as Pare, Felix Wiirtz and some of the earlier surgeons general of 
the Prussian Army. Of this rehabilitation of operative surgery by 
the lower caste, Allbutt says conclusively: 

Happily, if to the high stomachs of our mediaeval forefathers, surgical dabblings 
were common and unclean, still there remained some eyes curious enough and some 
fingers dexterous enough to carry the art back to the skill of Hippocrates and forward 
to the skill of Lister, and by the mouths of barbers and cutters, rather than of the 
pharisees of the colleges, medicine breathed her lowly message to her children. ^^ 

The Crusades 
(1096-1272) 

In the ninth century the Scandinavian Vikings began their raids 
upon the high seas, but wherever they established themselves, whether 
in Russia, France, England or Sicily, they were easily assimilated by 
the peoples among whom they settled and were rapidly converted to 
Christianity. As we see their lithe figures in the Bayeux Tapestry or 
the cathedral windows at Chartres, clad in chain-mail armor, from neck 
to knee, with pointed helmets, long shields and spears, the actions 
depicted suggest the incessant itch for fighting which was to make 
them, as Wells says, "the will and power of the Crusades." 

In preaching the First Crusade at Clermont in 1095, Pope Urban II 
said: 

Up till now, ye have undertaken unjust wars; in your insensate fury ye have 
discharged upon one another's houses the arrows of avarice and pride. Now, I 
propose to you wars which bring in themselves the glorious recompense of martyrdom, 
which will be the subject of eulogies from the present time to posterity." 

In like manner, the Abbe Guibert de Nogent said: 

Before the people set out upon this great expedition, the Kingdom of France 
was given over to trouble and the most cruel hostilities. Brigandage, incendiarism, 
attacks upon the public highways, combats excited only by unbridled cupidity, 
went on everywhere and without cessation.^* 

"Allbutt: The Historical Relations of Medicine and Surgery. London, 1905, 115>-120. 
"Cited by Caban^: Chirurgiena et blessfs k travers I'histoire. Paris 1918, 84. 
" Gaibert de Nogent: Gesta Dei per Francos. Cited by Cabanas. 84. 



Middle Ages 85 

One eftect of the Crusades, then, was to divert the warhke energies 
of the Nordics away from Western Europe to a distant object, namely, 
the menace of the Mohammedan and ^Mongol invasions, and while the 
Normans took up the gage with the cheerful "We are ready " of Josephus' 
Romans, the eight successive ventures occupied nearly two centuries 
and cost several million lives. The principal results were to increase the 
power of the Papacy, to whet the spirit of adventure and exploration, 
to enlarge the horizon of the mediaeval peoples by contact and commerce 
with the East, to postpone the fall of Byzantium for 300 years, to 
destroy the power of the feudal aristocracy through the loss of their 
estates, and to fasten chivalry and knight-errantry upon Europe until 
the end of the fourteenth century. To the improvement of military 
science the Crusades contributed nothing whatever. Of the medical 
arrangements of these expeditions we know little, for like all feudal forces 
they were, at the start, undisciplined caravans; but that physicians 
were in attendance upon the leaders is evident from the narrative of 
Baldwin's wound, the first important casualty in the First Crusade. 
Sustaining a spear thrust in the thigh and the reins, with syncope from 
haemorrhage, he was placed in a litter, "and thanks to the skill of the 
physicians and to his own strong constitution, was soon cured of a 
wound reputed mortal. "^^ The miniatures in the MS. of Lancelot du 
Lac (Bibliotheque Nationale, Paris)-* show that these litters, also 
described in the Old High German epics, were suspended between two 
horses, either tandem or abreast. The wounds incurred were either 
smashing blows on the skull from sword or battle-axes, incised wounds 
from slashing, or punctured wounds by spear or arrow, with great danger 
from external clotting and internal hemorrhaged^ Fighting in the hot 
sun, in the heavy hauberk or chain armor of the Normans, produced 
many cases of heat-stroke. The characteristic long triangular shield of 
the Crusaders was sometimes employed as a litter, to bear the wounded 
to safe places. On the Fifth Crusade (1216-20) scur\y was first noted 
and described by Jacques de Vitry, and on the Seventh Crusade (1249- 
54) the same disease was noted by Joinville (1250). Dysentery, the 
{)est, camp typhus and pernicious fevers exacted a heavy toll of lives 
on all the later Crusades. In spite of the religious motive of the 



" Cabanfes: op. cii., 89. 

"For reproduction, see Cabanes, p. 81. 

"Punctured wounds from spears and arrows occasioned but little bleeding, whence fatalities 
from internal hemorrhage were common (Cabanfes, p. 62) . This was the rationale of cupping, leeching 
and wound-sucking in such cases, and wound-sucking was also associated with the idea of poisoning of 
wounds by weapons. If the brain. che.-t or abdomen were deeply pierced by a spear or arrow, the 
imbedded weapon could not be withdrawn without great laceration of friable tissues: the patient's 
chances, then, were either to bleed to death from internal hemorrhage or to die from the shock of 
sudden and violent withdrawal. 



86 History of Military Medicine 

Crusades and the high character of many of the leaders, these expedi- 
tions were usually accompanied by great hordes of female camp fol- 
lowers, and the general effect of wandering soldiery was to relax morals 
everywhere. But as syphilis was in the nature of a mild endemic 
spirochsetosis up to the end of the fifteenth century, we find no refer- 
ences to venereal disease in armies before that time. 

One far-reaching result of the Crusades was the creation of a number 
of knightly orders, which, as they grew in wealth and power, were 
destined to exert great influence upon the subsequent hospital move- 
ment of the Middle Ages and upon the organization of religious nursing 
orders that went along with it. Of these, the Knights Templar was 
purely military, while the Hospitallers or Knights of St. John and the 
Teutonic Knights existed to defend the Holy City, to aid and protect 
pilgrims and to nurse the sick. When Godefroi de Bouillon captured 
Jerusalem on July 15, 1099, the Crusaders assumed possession of the 
great Hospital of St. John of Jerusalem, originally built by the mer- 
chants of Amalfi for the benefit of sick and indigent pilgrims. The 
order thus established, known as the Hospitallers of Jerusalem, became 
in time the Knights of St. John (1211), the Knights of Rhodes (1311), 
the Knights of Malta (1530), and while the establishment at Malta was 
broken up by Napoleon in 1798, the order still keeps up its traditions 
in England and Italy .^" The order of The Teutonic Knights of St. 
Mary's Hospital at Jerusalem grew up around a hospital established 
there by the Germans in 1143 and around another erected at Acre by 
merchants of Bremen and Liibeck about 1190-91. This order had its 
headquarters at Acre for a century (1191-1291), but in 1309 it trans- 
ferred its seat of government to Marienburg, where several fine hospitals 
and a hotel des invalides were built. In 1229 the Teutonic Order began 
to establish strong fortresses all over Prussia, after the fashion of the 
Normans in England, and by the fourteenth century it had practically 
subjugated ail of Prussia and Lithuania, which conquests it was des- 
tined to hand on to the Hohenzollerns (1525). The castles, hospitals 
and chapter-houses erected by the Teutonic Knights all over Eastern 
Prussia were, from a sanitary viewpoint, the finest structures of the 
Middle Ages, having subterranean heating plants and water-piping 
(or wells sunk on the premises), baths and wash-rooms, chimneys 
specially designed to carry off the thick vapors of torch-lighting, rooms 
arranged around a great central court, with arcades, and Dansker- 



"• For the early and subsequent history of this Order, see Rose G. Kingsley: The Order of St. Joho 
of Jerusalem, London. 1918 and Major A. C. Yate: The Knights Hospitallers and Ambulance Work 
in War. Jour. United Service Inst., London, 1900, xliv, 1099-1138 



Middle Ages 87 

anlagen or tower-latrines, separated from the main building by lengthy 
galleries, with running water-courses underneath to remove excreta. ^^ 

Wound-Treatment in the Mediaeval Epics and Romances 

In the Germania of Tacitus we get the first inkling of the part to be 
played by women in the care of the wounded during the Middle Ages : 

The strongest incentive to courage lies in this, that neither chance nor casual 
grouping makes the squadron or the wedge,^^ but family and kinship; close at hand, 
too, are the dearest, whence is heard the wailing voice of woman and the children's 
cry; here are the witnesses who are in each man's eye most precious; here the praise 
he covets most. They take their wounds to mother and wife, who do not shrink 
from counting the hurts and demanding a sight of them;*^ they minister to the 
combatants food and exhortation. Tradition relates that some lost or losing battles 
have been restored by the women, by the incessance of their prayers and the baring 
of their breasts; for so it is brought home to the men that the slavery, which they 

dread more keenly on their women's account, is close at hand Further* 

they conceive that in woman is a certain uncann\- and prophetic sense; they neither 
scorn to consult them nor slight their answers (Germania, 8j. 

This note of the special fitness of women as nurses for the sick and 
wounded is constantly sounded in the mediaeval epics and romances of 
chivalry. Care and treatment of the wounded became a particular 
function of great ladies. 

From wandering "wise women" (weise Frauen) and "wild women" 
{wilde Frauen), who culled healing plants and practised herbal medicine, 
the German warriors are said to have acquired skill in wound-treatment. 
Thus, in the epic of Gudrun (1210), an old warrior's proficiency in 
medicine is described as such that his possible earnings could not be 
carried away on a camel's back: 

Er war der Heilkunst kundig, man hat es langst vernommen, 
Erlernt hat es der Recke von einem wilden Weibe, . . . 
Da fand der Heilkunst Meister viel zu thun umher, 
Sollt" er sich Gut verdienen im grossen Kriegesheer, 
So konnten es Kameele nicht von der Stelle tragen." 

Long before this time there are plenty of evidences of wound-treat- 



" Sudhoff: Dresden Catalogue, 1911, pp. 155 and 159 (items 5686-5698). Sudhoff also notes 
the superior sanitary arrangements of the Palazzo Davanzati in Florence (1300), recently restored. 
In point of architectural beauty, such mediaeval structures as the Musician's House at Reims, the 
house of Agnes Sorel at Orleans, or the Hotel de Cluny (Paris), rose to great heights of perfection, but 
the sanitary arrangements were usually poor. Flinders Petrie observes that the Norman castle, "with 
its jealous corkscrew stairs," was conditioned by the fact that "almost any man was a possible assa.<^8in, 
and the greatest care was needed for safety against open or private attack on leaders" (Some Sources 
of Human History, London. 1919, p. 36). 

^- tiirma (squadron), a cavalry formation; cuneus (wedge), an infantry formation. 

" " Ad matres. ad conjuges vulnera ferunt: nee illae numerare aut eiigere plaga." pavent." Eiigere 
has taxed the in^rcnuity of the commentators; some are tempted by the reading exsugere, which would 
imply wound-sucking. 

'•Gudrun. viii. 5, lioes 326-534. Cited by Frolich: Deutsrhes Arch. f. Gesch. d. Med., Leipz., 
1830. iii. 229. 



88 History of Military ^Iedicine 

ment by barbarians, e. g., on a vase of the fourth century B. C, 
excavated at Kovl-Oba in the Crimea, which shows Scythian chieftains 
extracting a tooth and bandaging a wounded leg; or in the references 
in the Norse Eddas (circa 874 A. D.) to healing herbs, cauterization 
and other barbaric phases of wound-treatment. In the Nihelungenlied 
we read that the King of Burgundy and his brother looked after the 
transportation and care of their wounded vassals, placing them in 
comfortable beds; and that "skilled leeches, who healed the heroes after 
battle, were offered unweighed silver and bright gold."^^ In the later 
epics and romances, whether of Germany, France or England, women of 
high degree appear everywhere as nurses of the sick and healers of 
the wounded, the most celebrated being Queen Isolde of Ireland (of 
the Tristram legend), who figures in all the Arthurian romances. In 
the Chansons de Gestes, the Parzifal of Wolfram von Eschenbach (1204) 
or the Mort d' Arthur of Sir Thomas Malory (1485), it is either a hermit 
or the fair lady of some nearby castle who binds up the knight's wounds, 
when this service has not been rendered by one of his fellows; in the 
many accounts of battle-wounds in the Chanson de Roland there is only 
one reference to wound-dressing, viz., where Roland tears up his tunic 
to make a compressive bandage for the wounded Turpin. From the 
scattered details in these epics,^^ we get a composite picture of this 
phase of mediseval custom, which, with some exaggerations, is perhaps 
as close to fact as the homely details of English life in Crabbe or Words- 
worth or Tennyson. 

We see the wounded knight laid upon the ground, his wounds examined, washed 
and bandaged, often with a wimple (Kopftnck) from a woman's forehead;''' the 
various practices of giving a stimulating wound-drink'^ to relieve faintness, of pouring 
oil or wine into wounds, of stanching hemorrhage or relieving pain by sundry herbs, 
of wound-sucking to prevent internal hemorrhage,'' the mumbling of charms over 
v.ounds;^" the many balsams, salves and plasters used in wound-dressing; the feeling 
of the pulse in the cephalic, median and hepatic veins to ascertain the patient's 
chances of recovery;'" the danger of suffocation or heat-stroke from the heavy 
visored heimet and coat of mail; the eventual transportation of the patient by hand, 
on shields or litters, on horseback or on litters attached to horses;^- the sumptuous 



3° Frolich, op. cil., 229. 

^ For the French epics aod romances, see Cabanes: Chirurgiens et blesses k travers I'histoire, Paris, 
1918, 54-74. For the German, W. Uaberling: Die Verwundetensorge in den Ileldenliedern des Mit- 
telalters (Jena, med.-hist. Beitr., 1917, Heft 10). For Malory's Mori d'Arlhur, G. M. Gould and 
W. L. Pyle: King .Ajthur's Medicine. Johns Hopkins Hosp. Bull., Bait., 1897, vii, 239-246. 

"Wolfram von Eschenbach: Parzifal, x, 141-142. Cited by Haberling. 

" See A. Raubach: Ueber die Wundtranke in der mittelalterlichen Chirurgie. Berlin, 1898. 

"e. g., Parzifal, x, 94-109. 

*o Parzifal. x, 143. 

«' e. g. in the Krone (lines 6653-6671) of Heinrich von Tiirliu (1220), ciled by Ilaberliug, p. 19 

*- For melliods of transportation, see Haberlini: 36-39. 



Middle Ages 89 

chambers and couches reserved for the high-born, and the calling in of physicians,*' 
'usually from the famous schools of Salerno or Montpellier, in grave cases. The 
ministrations of womankind are always depicted with great charm, and prelude the 
organization of sick nursing in the later mediaeval period. 

In the Chronicles of Froissart (1337-1410), the Herodotus of the 
Hundred Years' War (1336-1453), we can glean many details of the 
military medicine of the fourteenth century. The tales of instant 
death or of cleavage of the body or the skull by smashing, heavy- 
handed sword strokes are as frequent, and perhaps as exaggerated, as 
those in the Chanson de Roland; but in Froissart, the constantly recurring 
references to bringing the wounded to some house nearby (au logis) 
and to getting them into a comfortable condition by suitable dressings 
(meitre a point les navres et les bless Ss) lead to the conclusion that this 
was common practice in the French army in the period. 

Beyond these simple details, nothing whatever is related as to the further history 
of the wounded; only the Homeric alternative : death or recovery. There were appar- 
ently no professional surgeons attached to these fourteenth century armies. Evacua- 
tion and wound-dressing were performed by comrades; the wounded nobles were 
dressed by their pages and squires, and litters were sometimes ordered to convey 
them to safe places in nearby fortresses or cities. The old chronicler revels in lengthy 
details about the food supplies — the biscuit, salt meats, cereals, wines, beer {cervoise) 
and the beef, mutton and pork on the hoof. He tells of the poverty, penurj' and 
abstemious diet of the Scotch soldiers, of their worries lest any wounded be left 
behind; of the national concern of the English for creature comforts, their cooking 
stoves, handmills for grinding grain and lavish commissariat; of the traveling kitchens, 
bakeries and portable barracks of the French; the vinegar doled out as a ration 
in lieu of wine, as among the Romans; the boxes of salves, bandages and lint in the 
supply trains. Froissart's account of the camp at Chisay (Poitou) in 1372 may be 
compared with the Roman camp in Josephus. He describes at length an epidemic of 
jaundice (1378), a probable epidemic of typhus (1385), the epidemic of plague, of 
gastro-intestinal type, which caused the raising of the siege of Lisbon (1384), and a 
number of cases of heat-stroke (1391). Dysentery and malarial fever appear, from 
his descriptions, to have been the regular scourges of the French army at this time.*^ 

Further Progress in Military Medicine and Surgery 
To England is due the credit of making the first attempt at an 
organized medical service in the Middle Ages, apart from the Byzantine 
Empire. Withington^^^ accounts for this innovation as follows: 

When Prince Edward was stabbed in Palestine, it is very doubtful whether the 
wound was sucked by his wife; but there is good evidence that it was excised by an 
English surgeon, and the success of the treatment perhaps inspired him with respect 
for the healing art, for we find him accompanied in the invasion of Scotland (1299- 
1301) by no less than seven medical men. They included a king's physician and two 

" In the French literature of the period, the laic barbers or apothecaries are styled mires, the clerica I 
physicians medecins. 

** For a full account of military medicine in Froissart, giving all the citations, see the close study 
by medecin-major Henri Favrier in France mM., Par., 1901, xlviii, 409; 452; 190-; xlix, 4; 19. 

« E. T. VVithington: Medical History, London, 1894. 22:!-224. 



90 History of Military Medicine 

junioFS (valetti), a king's surgeon and two assistants (socii), and a simple surgeon. 
The king's physician and surgeon each received a knight's pay — two shillings daily; 
and the others, who ranked as esquires, half that sum. That they found plenty to 
do is indicated b' the fact that the chief surgeon got compensation for three horses 
killed in Scotland "on the king's service." But this germ of a medical staff seems 
to have undergone no further development,^^ for we hear nothing of military surgeons 
during the wars of Edward III, e.xcept that the Welshmen who fought at Crecy were 
accompanied by one of their own race. In the following century appear the often- 
quoted names of Nicholas Colnet, physician, and Thomas Morstede, surgeon, who 
went with Henry V to Agincourt. Both were attended by three mounted archers, 
and Morstede had, in addition, twelve members of his own craft as his assistants. 
Colnet and Morstede were to receive one shilling, and their attendants six pence per 
diem, together with a share of the plunder, and their part of "the usual bounty," 
viz., 100 marks (£66 13s. 4d.) per quarter for every thirty men during the actual 
campaign. If they got all this they were well paid indeed, but only one receipt has 
come down to us, in which Colnet acknowledges the payment of £8 6s. 8d. as half- 
quarter's salary for himself and his archers. Another surgeon, William Brede- 
wardyn, seems to have been afterwards associated with Morstede, and they were 
allowed two waggons and a chariot for their baggage. 

Military surgery was backward in mediaeval France, England and 
Germany, for the reason that the general practice of surgery among the 
people was in the hands of barbers and bath-keepers, whose avocations 
were venesection, cupping, leeching, giving enemas and extracting teeth. 
About 1201, the College de St. Come was founded in Paris by Jean Pitard 
who had accompanied Saint Louis (IX) to the Holy Land, and divided 
its membership into the clerical "surgeons of the long robe" and the 
lay-barbers or "surgeons of the short robe." It was not until 1372 
that the latter were permitted to treat wounds. As time went on, 
both clerics and barbers were despised by the internists. In England, 
the master surgeons formed a separate guild in 1368, combined with 
the physicians about 1421, while the barbers obtained a separate 
charter in 1462. In Germany, barber-surgery was first pronounced 
"honorable" by Emperor Wenzel in 1406. The constant strife between 
these three guilds was not composed for centuries. Meanwhile the 
Middle Ages numbered some very eminent surgeons, notably Roger of 
Palermo, Hugh of Lucca, Bruno of Longoburg, and Theodoric, Bishop 
of Cervia, all of whom were pioneers of the dry or Hippocratic (aseptic) 
method of wound treatment, in which they were later sustained by 
Henri de Mondeville (1260-1320), a pupil of Lanfranc, and opposed by 



" Most of the efforts at organization and administration were tentative and fitful, e. g., the rule o 
Adolf of Nassau that wounds should be bandaged in camp and not in the field (1298), or the privilege 
of "un sirurgien pour leur carer lews playes, blessures el navreures" accorded to the police organization 
known as the sergenls du verge da Chdlelel at Paris in 1405. Frolich (op. ci7., 238-239) records the indis- 
criminate slaughtering of the helpless and wounded in the Swiss and German wars, e. g., at Sempach 
(1386) and Dofflingen (1388), and by the Turks at Nicopolis (1396). Mutilation of the wounded and 
of prisoners by Turks after a battle is the subject of an elaborate engraving in Gottfried's Chronik 
(1629). 



Middle Ages 91 

Guy de Chauliac (1300-68), the most learned and versatile surgeon of 
his time. Saliceto (1210-77), who sutured nerves, recognized the 
venereal cause of chancre and described renal dropsy, had seen military 
service, as had Hugh of Lucca, John of Arderne (1306-90), who devised 
an admirable operation for anal fistula, and the Fleming, Jean Yperman 
(129o-13ol), who made many innovations. The Bavarian army 
surgeon, Heinrich von Pfolspeundt, first mentions powder burns and 
describes the extraction of bullets by means of the sound (1460), while 
gunshot wounds are first described in detail by the two Alsatian 
military surgeons, Hieronymus Brunschwig (1497) and Hans von Gers- 
dorff (1517). These treatises, however, belong to the literature of the 
German Renaissance. 

Public and Military Hygiene in the Middle Ages 

The Feudal System, with the intense individualism and fierce 
rivalries of its overlords, did not make for the spirit of cooperation 
and subordination to the common weal which are essential to good 
government, and as part of the biological process of upbuilding nations, 
the spirit of the times became more and more coUectivistic. Of this 
historic phase Allbutt gives an illuminating exposition :^^ 

"If we inquire more closely how medicine fared in the fiery youth of modern 
Europe, we may offer at any rate two parts of the answer: first, the iron rule of prince 
and prelate, wicked as individual rulers have been, was possible because the peoples 
felt instinctively the radical and universal need of the age to be that the elements of 
the new Europe should be welded into a stable and coherent whole. This passionate 
idea of unity, called now the Church, now the Empire; here visible as the feudal tramp 
of the crusades, there as the tyrannous vociferations of the schools, would brook 
no schism, ecclesiastical, social or personal. As of every other sphere, so this spirit 
of domination took possession of Medicine, and therein set up the idolatry of Galen 
as inexorably as that of Aristotle in the sphere of philosophy. Whatever at one period 
were the constructive effects of this despotism, when it had outlasted its time it 
became as oppressive to Medicine, and to all knowledge, as formerly it had been 
socially integrative. 

"Secondly — or indeed it is another aspect of these reflections — the soul of the 
Middle Ages was a collective soul; its great works were the offspring not of individuals 
but of peoples. Who built the minsters; who painted the windows and the Books 
of Hours; who wrote the liturgies and chansons, we know not. As the churches, the 
liturgies, the manuscripts, the poetry and drama were achievements not so much of 
persons as of congregations, so also mediaeval learning was for the most part the 
learning of inspired crowds at the heels of a rhetorician. 

"Thus all this mediaeval achievement, fervid and beautiful as it was, could not do 
much for science; nor even for the intellectual harmonies of the fine arts. As the 
mediaeval spirit was multiform and catholic, the Greek spirit on the contrary was 
choice and personal, and owed its being to individuals — to Ictinus and Mnesicles, 
Phidias and Polygnotus, Homer and ^Eschylus, Plato and Aristotle, Mantegna and 



" Allbutt: The Historical Relations of Medicine and Surgery. London, 1905; Preface, pp. ix-xi. 



92 History of Military Medicine 

Donatello. The Greek was an individualising and an emancipating spirit, the 
mediaeval collective and enthralling — a genius of assemblies and associations of men." 

The most striking effect of collectivism was the development of 
public hygiene, in which the rulers, physicians and public officers of 
the Middle Ages did their best work. As in the first half of the nine- 
teenth century, thesfe developments were necessitated by the terrible 
ravages of epidemic diseases, notably the bubonic plague or Black 
Death (1348), otherwise known as the Great Mortality because it 
destroyed over one-fourth of the entire human race, leprosy, syphilis, 
influenza, St. Anthony's fire (erysipelas or ergotism), sweating sickness 
and Plica Polonica. These diseases were spread in epidemic proportions 
by wandering soldiery and outlaws and through the squalid, crowded 
condition of the population in the walled mediaeval towns. In the 
14th century some eight diseases, viz., plague, phthisis, epilepsy, scabies 
(syphilis), erysipelas, anthrax, trachoma, and leprosy, came to be 
regarded as contagious, and measures were taken to isolate carriers, 
to prevent them from entering cities, to prohibit them from selling 
food or beverages, or to drive them from communities. This doctrine 
of "eight diseases" originated with Rhazes in the 10th century, was 
stereotyped in a current Latin verse and was written into the public 
ordinances of towns. The leper was condemned to "civil death," 
and from the time of Gregory of Tours (560), lazar-houses or leper 
hospitals increased in number until there were about 220 in England 
and Scotland and 2,000 in France alone. By this process and through 
the introduction of quarantine against plague by the Venetian Republic 
the two most formidable pandemics were eventually stamped out. Of 
the deep historic sigificance of these applications of the Biblical code 
of sanitation, Sudhoff writes as follows :^^ 

"Although Greek medicine became of incomparable importance in general human 
progress and bases its title to fame chiefly upon the substitution of the investigation 
of natural aetiology for the supernatural demonic medicine, which ruled the whole of 
pre-Hippocratic Orient and Occident (Mediterranean and North Alpine) and still 
enslaves part of the world, it is a most interesting fact that, despite its theory of 
natural causation, Greek medicine was blind to the fact of contagion, of the direct 
transmission of disease. Whence so glaring a defect in the face of such keen percep- 
tion of the processes of nature.' Thucydides' history of the Athenian plague shows 
that these facts had not entirely escaped the Greeks, but Greek medicine passed 
them by, perhaps, because a natural explanation seemed impossible, since the 
populace so readily satisfied itself with the "Evil Eye" and similar imaginations. 

"Along the Euphrates, however, we come early upon the concept of a chronic, 
rarely curable disease, characterized by cutaneous changes and capable of transmis- 
sion to others. Babylonian culture in fact readily drew the proper conclusion and 
translated knowledge into action: Those aflFected with this disease must be debarred 
from intercourse with the healthy. . . . 

" SudhofiF: Ann. Med. History, N. Y., 1917-18, i. 115-117. 



Middle Ages 93 

"When leprosy fell upon the ancient world from the East, and came to the cogni- 
zance of Greek physicians, especially of Alexandria, these met its appearance with 
an admirable establishment of the semeiology, without penetrating deeper into 
epidemiological questions or recording any prophylactic measures of segregation. 
Egypt, where in Hellenic times leprosy spread and became established, was then its 
general sally port in the West and is, even today, one of its principal fields of 
activity. From Egypt, the disease in sluggish epidemic form traversed North 
Africa, crossed the strait of Gibraltar with the continuous stream of travelers, and 
spread over Moorish Spain; at the same time the germs were carried by the constant 
migrations across the Mediterranean to Italy and Southern France, across Byzantium 
to the Balkan and Danube states. The network became especially close over 
Southern Gaul, and even farther into Celtic domain, over which a Germanic stratum 
had been deposited; here, authentically in the sixth century, the thought of rending 
or cutting the threads of the epidemic which coursed over the lands was initially 
entertained. Enlightened princes of the church, moved by the increasing misery 
of the people, on the strength of the sacerdotal code of the Old Testament, undertook 
the task of interfering; the shepherdess of the mediaeval peoples knew her duty. 
The Council of Lyons (583) attempted to restrict the free migration of lepers. The 
edict of Rotharus, King of the Lombards, demonstrates what advances this idea 
made in sixty years; the acts of Charlemagne, one and a half centuries later, show 
the same trend; the leprosy decretals of the third Lateran Council (1179) represent, 
in a measure, the last word of the church. Apprehension of lepers became general 
routine in the territories of the ecclesiastical and secular princes of France and 
Germany; isolation camps were established everywhere, gradually increasing to 
thousands. Thither the lepers and suspects were taken, the former civilly dead 
for the rest of life. This system was mercilessly enforced for centuries with perfect 
success. In this tenacious fight of centuries, the methods of which were borrowed 
from the Mosaic Code, the Occident triumphed over leprosy. Guided by this intellec- 
tual torch, it accomplished the first great feat in direct prophylaxis; methodical 
eradication of leprosy- by consistently making the affected individuals harmless as 
carriers of the virus. Light from the East is transformed to pulsating energy by 
the European peoples, while the disease swings its lash unchecked in the Orient. 

"The same light, rising for Occidental and Mohammedan physicians alike, spent 
its luminosity over a second great battle, which constitutes an additional title to 
fame for the Middle Ages: the campaign against an acute infectious disease, which, 
like the destroying angel, again coursed over the Mediterranean from the Orient, 
the plague. Stirred by the "Black Death," which arose about the middle of the 
fourteenth century, the public officials of Italy and Southern France, during suces- 
sive decades into the next century, with Venice and Marseilles as pioneers, created 
the whole system of sanitary control of incoming vessels, of observation stations, 
isolation hospitals and methods of disinfection. All this was adopted by modern 
hygiene, in more definite and rigorous form, with relatively few changes. An ener- 
getic attempt to establish order in the infected cities was made, without, however, the 
consistency and purposefulness of the prevention of importation. Three dates may 
be cited in this connection: 1374, Venice, being again threatened by importation of 
the plague, denied entry to the city of all infected or suspected ships, travelers and 
freight; 1377, Ragusa, in Dalmatia, rejected all travelers from plague districts, who 
had not sojourned for a month at one of two designated points, without developing 
the disease; 1383, Marseilles erected her first quarantine station, at which, after 
rigid inspection of the vessels, all travelers and cargoes from stricken or suspicious 



94 History of Military Medicine 

siiips were detained for forty days, exposed to air and sunshine. Tliese are the 
principles of preventive medicine in the Middle Ages, created by physicians and 
authorities in common endeavor, in amplification of an idea called into being by the 
campaign against leprosy." 

The various religious orders did much for sick nursing, the Benedic- 
tine monasteries were frequently provided with infirmaries, and the 
hospital movement initiated by Innocent III in 1198 led to the founda- 
tion of such institutions all over Europe. At first these hospitals 
were only retreats for the sick, infirm or indigent, but the necessity of 
treating syphilitics by inunction and sweating initiated the actual 
treatment of diseases in hospital, and there came to be hospitals for 
the curable {curabiles, ergo curandi) as well as the incurable, and isola- 
tion hospitals for communicable diseases.^^ The pamphlet literature of 
plague-tracts and of directions for the personal hygiene of the nobility, 
or of those undertaking long journeys and sea-voyages, was enormous. 
The following chronology of city ordinances and hygienic manifestos, 
most of them exhumed by Sudhoff, shows the trend of the mediaeval 
period in public hygiene: 

1204 Opening of the Santo Spirito Hospital at Rome. 

1214 Appointment of city physician at Bologna at a fixed salary. 

1224 Edict of Frederick II regulating the practice of medicine. 

1231 Salerno constituted a medical school by Frederick II. 

1231 Ordinance of Frederick II against pollution of the atmosphere, adulteration 

of food and drugs, sale of poisons and the watering of wine. 

1302 First judicial post mortem (Bologna). 

1316 City surgeon at Liibeck at 16 marks per annum. 

1350 Ordinance of city of Basel specifying "eight diseases'" as contagious. 

1357 [and later] Forensic protocols on suspected lepers. 

1374 Ordinance of Cologne confining slaughtering of animals to city abattoir. 

1374 Ordinance of Reggio against plague. 

1374 Venetian Republic excludes infected and suspected ships from pratique. 

1377 Ragusa exacts 30 days quarantine. 

1383 Marseilles exacts 40 days quarantine. 

1388 Parliament of Cambridge on soil pollution as a cause of disease. 

1388 Salaried city veterinarian at Ulm. 

1403 Venetian Republic establishes time limits of quarantine {qnaratita giorni). 

1409 Insane asylum at Seville. 

1427 Ordinance of Ulm against smoky chimneys. 

1452 Ordinance of Ratisbon regulating midwifery. 

1464 Quarantine station established at Pisa. 
1464-75 Tucher's Baumeisterhuch (against heaps of manure, disposal of sewage in 

streets, and requiring lanterns on street corners). 

1494 Sebastian Brant attacks adulteration of wine, sausages, sugar and saffron. 

1495 Syphilis first mentioned in the Edict aginst Blasphemers of Maximilian I. 

In the writings of Arnold of Villanova (1235-1312) is included a 



*» Pagel-Sadhoff: Einfuhrung ia die Geschichte der Medizin, 2. Aufl. Berlin, 1915, 188. 



Middle Ages 95 

tract on the hygiene of troops in camp {de regimine castra sequentium) 
of date 1498: 

Arnold recommends that an army should pitch its camp on level ground, away 
from swamps, facing east or west; that water should not be taken from springs 
containing slimy sticks of wood, nor from wells or cisterns containing slimy matter, 
nor from any part of a river in which beams of wood are immersed. To ascertain 
if well-water is impure, a thin, clean, piece of white linen should be dipped into it 
and later hung in the sunlight to dry; if spots of any color appear, such water is to 
be avoided. To prevent epidemics, a trench should be dug outside the camp to 
contain the cadavers and dejecta of animals, which is to be covered again with 
earth, when half full. The rest of Arnold's tract is made up of mediaeval prescrip- 
tions and recipes, for which reason von Toply believes it should be attributed to 
some other author.^" 

Introduction of Camp Hospitals and Ambulances 
In mediaeval Spain military medicine was further advanced than 
is commonly supposed. Physicians and surgeons accompanied the 
Spanish armies on campaigns, and in Moorish Spain, in the thirteenth 
century, there were hospitals of the Arabic pattern, in which the patients 
were distributed according to sex and kinds of diseases, with convalescent 
wards, attendants and courses of medical lectures. In the chronicles 
of the conquest of Granada and the expulsion of the Moors by the 
armies of Ferdinand and Isabella we find definite evidence of the 
establishment of camp hospitals and ambulance service by the Queen. 
Six large hospital tents were in use at the siege of Alora (1484) and four 
at the siege of Baza (1489). Wagons provided with beds are said to 
have been used at the siege of Otrera (1477-8), and on the day follow- 
ing the capture of Malaga (August 19, 1487), some 400 of these entered 
the city. Through the courtesy of Drs. Edward T. Withington (Oxford) 
and Charles Singer (London), it is possible to give the original citations 
bearing upon Queen Isabella's ambulances and hospitals :^^ 

1. From the account of the siege of Alora (1484) by Hernando del 
Pulgar f- 

£ para curar los feridos e los dolientes, For the care of the sick and wounded, 

la Reyna embiaba siempre a los reales the queen sent always to the camp six 
seis tiendas grandes, e las camas de large tents and their furniture, together 
ropa necessarios para los feridos y with physicians, surgeons, medicines 
infermos; y embiaba fisicos e cirujanos and attendants; and commanded that 
e medicinas e hombres que los serviesen, they should charge nothing, for she 
emandaba que no llevasen precio alguno, would pay for all. In the camps, these 
porque ella lo mandaba pagar. Y estas tents with their appointments were 
tiendas con todo este aparejose llamadan called the Queen's Hospital. 
en los reales el hospital de la Reyna. 

'" R. von Toply: Die Lagerhygiene des Arnold von Villanova. Militararzt, Wien, 1896, nx. 97; 
113: 1.3.3; 149. 

" The references and translations were first given by Dr. Withington in his -Medical History, Loiuion, 
1894, 224-22.i. 

"Hernando del Pulgar: Cronica de l<>s Reyes Catolicos (III, 331, Valencia, 1770, 230. Also given 
in condensed fornn in Prescott's Ferdinand and Isabella. London, 1858, I. 366. 



96 



History of Military ]\Iedicine 



2. From an oration held before the Pope in the Consistory at Rome 
by the Valentian, Pedro Bosca (November 11, 1487):^^ 



Sequuntur item exercitum religiosis- 
simum, ne illi quicquid deese possit, 
quadrigenti ferme** currus, operti umbra- 
culis quod hospitale reginae appellant; 
in quibus impensa regia et sumptu 
amplissimo, quicquid curandis egrotis, 
sive ex acie vulneratis arte medica vel 
cyrurgica necessarium esse potest in- 
venitur; honestissimis et probatissimis 
matronis huic muneri servientibus ad 
ministrantibus. Xulla scorta, nulli le- 
nones, nulla periuria, nulli denique 
sortium ludi in exercitu admittuntur, 
ne cuique pessime aut perperam agendi 
occasio dari valeat. 



That nothing might be lacking, the 
most devout army was followed by 
about 400 ambulances, covered with 
awnings, which (train) was called the 
Queen's Hospital; in these, at the 
Queen's expense and in lavish outlay, 
was found everything necessary to the 
art of medicine and of surgery for the 
treatment of the sick or the wounded 
from the ranks; those attending and 
ministering to this duty being matrons 
of the most honest and trustworthy 
character; no prostitutes, no panderers. 
Ho perjury, no games of chance were 
permitted in the army, lest anj'one 
might find opportunity to behave dis- 
honorably or improperly. 



3. From the letter of Peter Martyr to the Archbishop of Milan on 
the siege of Baza (1489) : 



Hospitalia post haec tentoria quatuor 
ingentia, providum Reginae pietatis in- 
ventum, est operae pretium videre, ad 
remedium haec et medelam non saucio- 
rum modo, sed quovis morbo laboi-antium 
erecta. Medicorum, pharmacopolarum, 
chirurporumque et reliquorum ad minis- 
teria addictorum, is est numerus, is est 
ordo, ea diligentia rerum ea copia, ut 
neque suburbano vestro Sancto Spiritu, 
neque vasto illi tuo Mediolanensium 
cedant hospitalibus. Regia impensa 
quicquid languoris, quicquid accidentis 
emergit. ni status cuique a natura dies 
assit absconditur.55 



Four huge hospital tents, the careful 
provision of queenly piety, are a sight 
worth seeing. They are intended not 
only for the wounded, but for those 
laboring under any disease. The phy- 
sicians, apothecaries, surgeons and other 
attendants are as numerous, the order, 
diligence, and supply of all things needful 
as complete as in your Suburban 
Infirmary of the Holy Spirit or your 
gj-eat Milan Hospital itself. Every 
sickness and casualty is met and pro- 
vided for by the royal bounty, except 
where Nature's appointed day is at 
hand. 



Queen Isabella herself visited the wounded in the field, and when 
some of her grandees hinted that this was contrary to Castilian etiquette, 
she replied: 

"Let me alone. These poor people have here no other mother to lighten their 
sufferings. Believe me, the only consolation our neglected subjects have is the 



»2 Pedro Bosca: Oratio Romae habita xi Kal. Novembris ad Sacrum Cardinalium Senatum Aposto- 
licum in celebritate victoriae Malachitanae (etc.) Rome. 1407. 

'* Ferme, from fere, nearly, almost, is wrongly translated by the Spanish historians /or^a/efirfos , 
i. e., strongly fastened. 

"Peter Martyr: Opus Epistolarura (No. 7'.i), Amsterdam, 16T0, 39. 



Middle Ages 97 

presence of their sovereigns, and if these cannot give their health back to them, they 
may at least inspire them with the courage to bear their troublesome diseases and 
painful wounds with patience." 

The admiring chronicler, Dr. Withington writes, concludes as follows: 
"Surely this queen deserved as much as those ancient Greek and 
Roman princesses the title mater castrorwn.'" 

The fall of Constantinople in the East and the end of the Hundred 
Years' War in the West both happened in the same year (1453), and 
with this date the mediaeval period really closes. Queen Isabella's 
ambulances were harbingers of the more generous and expansive spirit 
of the Renaissance. 



CHAPTER V 

The Renaissance Period 

In one of his addresses, President Lowell of Harvard observed : 

"It is hardly an exaggeration to summarize the history of four hundred years by saying 
that the leading idea of a conquering nation in relation to the conquered was in 1600 
to change their religion; in 1700 to change their trade; in 1800 to change their laws, and 
in 1900 to change their drainage." 

Even before 1600, and indeed following the Reformation (1517-34), 
most of the wars of the 16th century were religious wars. The most 
dramatic events of the period, the auios-de-fe (1482-1800), the Peasants' 
War (1524-5), the execution of Sir Thomas More (1535), the burning of 
Servetus (1553), St. Bartholomew's (1572), the execution of the Queen 
of Scots (1586), the Armada (1588) were all occasioned by the theological 
hatred which moved the religious of whatever persuasion to persecute 
and torment the heretics of their respective creeds. Antagonisms of 
creeds brought on such lengthy wars as those against the Huguenots 
(1562-1609), the Revolt of the Netherlands (1572-1609), the Thirty 
Years War (1618-48), and the wars waged by Louis XIV against 
Holland and Germany (1672-97). During the 15th and 16th centuries 
the art of war was profoundly modified by the introduction of firearms 
and artillery, which widened the distance between the fighting lines, 
gradually did away with armes blanches and revolutionized the practice 
of military surgery. At Crecy (1346), Poitiers (1356) and Agincourt 
(1415), the yeoman-archers of England had demonstrated their superior- 
ity over the feudal cavalry, while wandering knight-errantry had long 
before received its final crushing defeat at Mansurah (1250), the last 
battle of the Crusades. The straggling caravans of chivalry were re- 
placed by well-drilled bodies of mercenary heavy infantry, marching to 
drum and fife, such as the condottieri of Italy, the Landeslcnechte of 
Germany and Switzerland or the Swiss Guards (Suisses) hired by France, 
Spain and the Papal See. From these organizations, with their regi- 
mental system, was gradually evolved the modern concept of national 
armies. The fierce hatred everywhere engendered against lawless, 
swaggering mercenaries and military adventurers, e.g., in England after 
the Wars of the Roses (1455-85), forms the leading motive of Machia- 
velli's Art of War (1521).^ Readers of Charles Reade's "Cloister and the 



' Capt. C. p. Atkinson: Encycl. Rritan., Cambridge, 1910, II, 597-.S99. 
98 



Sixteenth Century 99 

Hearth" and similar books will recall how unsafe it was in this period 
to cross any part of continental Europe without arms or bodyguard. 
Yet this was the age which witnessed the Renaissance or Revival of 
Learning, and the Renascence or new-birth. of Western civilization, in 
which the invention of printing (1448), the dispersal of the Greek 
scholars over Europe after the fall of Constantinople (1453) and of the 
German printers after the sack of Mainz by Adolph of Nassau (1462) 
were factors of moment. In art and science, the period was one of 
extraordinary brilliancy, as witness such great figures as Leonardo da 
Vinci (1452-1519), Michael Angelo (1475-1564), Albert Durer (1471- 
1528), Shakespeare (1564-1616), Copernicus (1473-1543), Paracelsus 
(1493-1541), Vesahus (1514-64), and Pare (1510-90). The publication 
of a large body of scientific writings in the vernacular marks a distinct 
break with the past and Paracelsus w^as the first to discard the practice 
of lecturing on medicine in Latin. The grand achievement of Renais- 
sance medicine was the revival of scientific anatomy by Leonardo da 
Vinci (1512) and Vesalius (1543), which was followed by a host of 
anatomical discoveries, all of physiological import, and led to the 
rehabilitation of operative surgery by Pare and of experimental physiol- 
ogy by Harvey. 

While military surgery became a new thing in the hands of Pare, 
military medicine continued to lag behind and for the following reasons. 
Before the advent of Pare, educated surgeons, attached as of old to the 
persons of powerful nobles, did nothing whatever for the common sol- 
dier, and the few surgeons of lower caste, employed as a business insur- 
ance for the mercenary troops and required by them, were usually men 
of small education who acted as barbers for the oflScers. But as the 
mercenary organizations gradually merged into the standing armies of 
Charles VII (1448) and Maximilian I, the number of medical personnel 
for the rank and file was increased and better medical administration 
was thereby secured. Toward the end of the 14th century, over and 
above such evacuation of the wounded by comrades as we read of in 
Froissart, it had become customary to hire a number of barber-surgeons 
to treat the wounds of ordinary soldiery. Thus, while we find such 
able phj'sicians as Colnet and Morestede with Henry V at Agincourt 
(1415), Gersdorff with the Swiss Confederates at Grandson and ^Nlurten 
(1476), Gabriel Miron with Charles VII at Naples (1494), Marcello 
Cumano with the Milanese at No vara (1513), Symphorien Champier 
with Francis I at Marignano (1515) and Louis Desbourges at Pavia 
(1525), there begin to appear, in the city archives of the Swiss cantons 
and elsewhere, evidences of the authorized employment of barber sur- 
geons to treat the wounded at public cost. 



100 History of Military Medicine 

State Care of the Wounded by the Swiss Confederation 
In his carefully documented study of the care of the wounded in the 
wars of the Swiss Confederation (1315-1798),^ Dr. Conrad Brunner has 
demonstrated a fact hitherto unknown to historians, namely that 
Switzerland antedated all other nations of modern Europe in state care 
of the wounded, i.e., in actual municipal ordinances notifying the 
individual soldier that his government was behind him in respect of his 
welfare on the field of battle. 

When the cantons of Uri, Schwyz and Unterwalden concluded their pact of eternal 
federation (1291), there began a long series of bloody wars with outland enemies and of 
fierce internecine struggles between rival groups of cantons which resulted in the ultimate 
autonomy of the Helvetian Republic. At Morgarten (1315), Laupen (1339), Sempach 
(1386), Naefels (1388), Grandson (1476), Murten (1476), Nancy (1476), Giornico (1478), 
Dornach (1499), Xovara (1513) and the first day at Marignano (1515), the valorous Swiss 
were able to demonstrate repeatedly that whatever huge force confronted their small 
detachments was, like Bret Harte's grizzly, only a "coward of heroic size," and so well- 
earned and well-established is their reputation as sturdy, invincible fighters that their 
European neighbors have seen fit to leave them unmolested to date. 

Brunner's researches show that, from the date of the battle of Laupen (1339) onward, 
the accounts in the Swiss archives are replete with disbursements of moneys for the care 
of the wounded and their dependents. In the earlier period, these consisted of payments 
to various barber-surgeons for attending the wounded after battle, e. g., those made by 
the city of Berne after the Gugler War (1376), the siege of Burgdorf (1383) and the Zurich 
Wars (1436-50) or by St. Gall after the siege of Rheinegg (1405). This gradually became 
custom in all the cantons. In t-he archives of the Zurich Wars, we find the council of 
Lucerne authorizing that the wounded should continue to receive their pay as long as the 
troops remained in the field (1444). During the Miillhausen War, an order goes forth from 
Berne that Marcellin the barber shall accompany a well-equipped force of 130 men (June 
15, 1467). During the Burgundian campaign, (1474-77), a similar ordinance is issued by 
Basel, detailing two barber-surgeons to accompany the troops, with provisions for con- 
tinuing the pay of the wounded for the period of the war (March 30, 1474). In an 
order of the day following the battle of Grandson (1476), it is promulgated that all living 
expenses of the wounded and all costs for medical attendance shall be paid "in modera- 
tion" out of the common purse (May 15, 1476), with a subsequent protocol of account, 
showing expenditure of 300 guilders for 200 wounded or 13^2 guilders per capita. After 
Grandson, the council of Lucerne further decreed that the property of children orphaned 
by the war should be carefully guarded by the state, with restitution in case of embezzle- 
ment by oflScials; that the state should pay not only for treatment of the indigent wounded 
up to recovery, but should also pay for the maintenance of themselves and family until 
they were able to resume work. This is also verified by the city accounts of 1476. After 
the battle of Dornach (September 2, 1499), the Bernese devoted all the booty, a sum of 
800 pounds, to the maintenance of the wounded and of the widows and orphans of the 
slain. The account-books of both Berne and Solothurn for 1499—1500 show that these 
items continued to be paid out of the city funds. In the Italian campaign of 1500-29, 
the cost of caring for the Swiss wounded was borne by the Duchy of Milan, e. g., 4 guilders 
per capita after the taking of Pavia (1512). .\fter the battle of Kappel (1531), the city- 
accounts of Zurich for 1531-32, show a disbursement of 1358 pounds for care of the 



•C. Brunner: Die Verwundeten in den Kriegen der alten Eidgenossenschaft, Tiibingen, 1903. 



Sixteenth Century 101 

wounded, bandaging material, tips to surgeons' apprentices, moneys advanced to the 
wounded themselves, and expenses of sending convalescents to mineral baths, while 
expenses of wagon transportation amounted to 16 pounds or more. The non-transportable 
wounded were treated at public cost in an improvised hospital in the cloister at Oetenbach. 
After the peace between Berne and the five Catholic cantons (1533) sick and wounded 
war prisoners were allowed to return to their homes without ransom, upon payment of 
living expenses and cost of medical attention. In the so-called period of "capitulations" 
(1531-1000), in which the cantons hired out their troops to France, Spain and the Papal 
See, the financial obligation of caring for the sick and wounded is expressly stipulated in 
the tightly drawn contracts between the separate cantons and these neighboring states.' 
In the muster-rolls of detachments ordered to field duty by the different cantons during 
1371 to 1584 the names of the barber-surgeons and physicians detailed are always given 
In a muster-roll of Basel (1542), the title "field-barber" (Feldscher) appears for the first 
time, and chief field-barber {Oberster Feldscher) in a Bernese roster of 1589. On account 
of the fierce spirit of the times all medical personnel bore arms and before 1589 the field- 
apothecaries were not even listed among the medical personnel but participated as com- 
batants. As judged from the municipal account books, the fees accorded the barbers for 
field services and care of wounded after battles were handsome allowances for the times.* 
When the Swiss began to hire out their men-at-arms as mercenaries, they proved hard 
bargainers for their employers, whence the proverb, Point d' argent, point dc Suisse. Con- 
tary to French and German practice, no attempt was made to collect or relieve the wounded 
until after a battle. The so-called Sempach Pact (1393), concluded between nine cantons, 
specifies that the wounded should not attempt to escape during a battle, but were to 
remain standfast within the lines until the end of the action, lest they incur the penalty of 
desertion. Fighting in these early days was desperate and bloody, both the prisoners and 
wounded were commonly massacred, and no quarter was shown the enemy on either side. 
The Swiss Confederates were required to take a barbaric oath to spare none of the enemy 
and to permit none of their own men to be captured. This was customary until the begin- 
ning of the 16th century when return of prisoners and wounded was permitted. But 
once accepted, this humane principle was lived up to with characteristic fidelity and 
reliability, and it is significant that the Red Cross idea was eventually established by a 
Swiss, Henri Dunant. During the recent European war the peoples of the different 
Swiss cantons voluntarily displayed the most magnanimous charity toward the war 
prisoners and refugees within their frontiers, paying for their maintenance out of their 
own pockets, even to their own impoverishment, an object lesson in practical inter- 
nationalism to all nations of the civilized world. 

Reforms of Maximilian I and Later Developments 
The origins of standing national armies are commonly traced to the 
changes in militar}^ organization initiated by Charles VII of France and 
Maximilian I of Germany. To put a stop to the brutal plundering of 
the people by wandering mercenary soldiery, Charles VII (1-122-61) 
instituted compagnies (Tordonnayice, i.e., troops solely under the orders 
and authority of the king, and not likely to change sides at the instance 



' For example, in the contract made by the cantons of Wallis and Graubiinden with Leo X (1514); 
"1st abgeredt das babstliche Heligkeit denselben (i.e., the wounded) so lang sy in siner Hellgkeit 
dienst vnd vff der widerfahrt sind, Ireu soil bezalen vnd sy nit minder noch anders dann die woUmo- 
genden solle halten. " In the contract with Spain (1544), wagon transportation of the wounded is 
stipulated. Brunner, op. cit.. 57. 

'See. for examples, Brunner, op. ciC 52-54. 



102 History of Military Medicine 

of the highest bidder or to raid unprotected territory, in free-lance 
fashion, to suit the caprices of their reckless managing directors. These 
companies had an average strength of 600 men each, but no regular 
medical personnel. After the battle of Bosworth Field (1485) the 
example was followed by Henry VII of England, in his "yeomen of the 
guard," a small band of 50 archers.^ In like manner, Maximilian I 
(1459-1519) recruited his standing army of Landesknechte (native-born 
soldiers) from the people, principally as a weapon of offence against the 
menace of Turkish invasion. These were heavy foot-soldiers, armed 
with musketry as well as halberds, bows and arrows. This organization 
of Landesknechte, further developed by Charles V (1519-56), was prin- 
cipally fostered by Georg von Frundsberg (1473-1528), whose concern 
for the sanitary welfare of the soldier was highly praised bj' his contem- 
poraries. Its administration is described at length in the treatise on 
Imperial Courts-Martial of Leonhard Fronsperger (1555),^ whose in- 
structions to medical personnel were regarded by Frolich as the basis of 
the medical regulations of the modern German army.' In this organiza- 
tion each aggregation (Hauffen) of 5,000-10,000 men was divided into 
regiments, consisting of 10-14 or more "standards" {Faknlein) or 
troops of 400 men each. To each troop, each company of infantry 
(200 men), and each squadron of cavalry was assigned a barber-surgeon 
(Feldscher) at a double salary of 4 guilders monthly. The commander 
of each Hauffen had attached to his staff a field physician-in-chief 
(Obrist-Feld-arfzei) and a field-barber (Doktor und Feldscher). The field 
marshal of cavalry had a physician (Doktor der Artzeney) and the Chief 
of Artillery a surgeon (Wvndart'.et), at a monthly salary of 30 guilders, 
with an assistant barber (Scheerer). The field-barber ranked between 
a clerk and a halberdier or between a quartermaster sergeant and 
a corporal. 

Fronsperger's regulations concerning the physician-in-chief and the 
field-barbers have been translated by Heizmann* as follows: 

The physician-in-chief must have been a doctor, or one who had recently charge of 
surpeons or field-barbers by state authority; he must be a well-known, skillful, experienced 
and cautious man, of the proper age, upon whom all barbers, sutlers, wounded, sick and 
stricken could rely for help and counsel in time of need, particularly when they are shot, 
cut, bruised or broken, or are suffering from any accidental or disabling diseases, such as 
scalds, fluxes, fevers, and similar affections that occur among soldiers. His duties are 
even more extensive in that he should inspect, both when the regiment is organized and 
later at monthly muster, the instruments and everything pertaining thereto, and when he 



' A. A. Gore: The Story of our Services under the Crown .London; 1879, .35. 

• L. Fronsperger: Vom Keyserlichen Kriegsgerechten, Malefitz und Schuldhandler, Ordnung und 
Regiment. Frankfurt am Main, 1555. 

' Frolich: Deutsches Arch. f. Gesch. d. Med., Leipz., 1880, III, 256. 
8C. L. Heizmann: .\nn Med. History, N. Y., 1917-18. I. 283. 



Sixteenth Century 103 

finds anything lacking or lost, such shall be charged to the field-barber, to make up the 
deficit. When this cannot be done, he shall find other means to meet emergencies. On 
the march he will closely attend his commanding officer. TNTien exigency or peril impends 
from the enemy, in battle array or skirmishes and such like, he shall remain in the neigh- 
borhood of his superior military officer; but he will also oversee as much as possible the 
other physicians, surgeons and the like, wherever wounded, etc., are to be attended, and 
he shall devote his care, advice and skill to all others, particularly because he, above 
others, is ready with instruments, apothecaries and medicines for both internal and 
external wounds and sickness. 

He should also with all diligence advise whether a leg, arm or such should be amputated 
or preserved by other means. Further, he should give his attention to the severely 
wounded, that they may not be left too long on the lines or in the companies, but imme- 
diately carried to the surgeons and aided by beneficial dressings. On the march, when 
it becomes important to have a field-barber near at hand or available, it is his business to 
see that one is stationed between the cavalry and infantry, with his instruments. On 
other occasions, in camp and quarters, each barber remains with the troop in which he 
has been assigned for duty. WTienever a question arises between barbers and cured 
soldiers or others as to the payment to be made, he shall settle it, seeing that neither too 
much nor too little is given. 

As it is necessary that a field-barber or surgeon serve with each troop, so should each 
Captain be careful to select a well-versed, skilful, experienced and trained man, and not 
a poor beard-shaver or bath-boy as often happens by reason of favor; thus, the killing or 
maiming of good soldiers may be prevented. The field-barber should be supplied with 
all necessary medicines and instruments in a field wagon, and the Captain should see 
that it is done. He should be a capable Knecht to help in necessity. His duty is to render 
assistance first, when there is need, to those of his own troop, not to exact too much from 
anyone, but to treat men at reasonable and like rates. He shall have his lodging at 
night at the company pennant so that he may be foimd in necessity, and it is best that 
one barber should be accessible to each lodging house, on account of the sick and wounded. 
He shall serve with his troop in all else like an ordinary soldier, and he shall receive double 
pay. 

Here we have a spirit of organization and a sense of discipline which 
shows considerable advance even upon Roman or Byzantine standards. 
In the armies of Charles V the sick and wounded were sent to the bag- 
gage train and put under tents (the field hospitals of his grandmother 
Isabella), where they were attended by physicians or barbers and nursed 
by the innumerable female camp-followers, who, as we shall see, lived 
with the soldiers as actual or putative wives, and with their children, 
performed the most menial duties. On breaking camp wagon trans- 
portation was employed for the light sick and shghtly wounded, while 
more desperate cases were sent to hospitals in the nearest towns. A 
Spitalmeister or hospital-superintendent, selected and paid by the 
Landesknechte in common, was delegated to look after the sick in hospital 
or on the march, and to furnish supplies. WTien the army moved for- 
ward couriers were despatched ahead to locate suitable quarters, in- 
cluding a house for the barber-surgeons and their patients. In battle 
the medical personnel were located with the rear-guard, with orders to 



104 History of Military Medicine 

bring the wounded out of the Hnes to a safe place and bandage them. 
In the field the sick or wounded continued to receive their pay.^ 

In France the armies of Charles the Bold, Duke of Burgundy (1433- 
77) had a surgeon attached to every company of 100 lancers, i.e., one 
surgeon to every 800 men, over and above the physicians attached to 
the Duke and his vassals. The lancers received twelve crowns monthly, 
the physicians five. The court of Charles had attached to it 6 physi- 
cians, 4 surgeons and 40 assistants, and it is said that even this personnel, 
large for the times, was not adequate to look after the wounds incurred in 
battle, jousting at tournaments and knightly exercises. Charles is 
highly praised for his fatherly care for the sick and wounded by the 
European historians. At the end of the century, as we shall see, station- 
ary military hospitals, with ambulance service for first aid, were estab- 
lished by Sully (1597), in the reign of Henri IV, and were so well managed 
that even high officers were content to be treated in them.^" 

When Edward IV of England (1461-83) joined the army of Charles 
the Bold in his campaign against Louis XI (1475), he had with his forces 
a chief physician, 2 body physicians, a surgeon and 13 assistant barber- 
surgeons. Prior to this time the field surgeons Colnet and Morstede, 
who accompanied Henry V to France (1415), with 15 assistants, were 
indentured to the King, with later authority to "press" surgeons and 
instrument-makers into the military service. Annuities were some- 
times granted to the severely wounded in this period, and by the time 
of Henry VIII (1509-47) a definite system of pay for soldiers and army 
surgeons was established, although the medical personnel, as described 
by Gale, was poor in quality. At the battle of St. Quentin (1557) the 
English Army had a regular medical staff consisting of 2 surgeons 
attached to the general, and one each to the lieutenant general, the 
high marshal, the general of horsemen, the captain general of footmen, 
and the master of ordnance, as in Fronsperger's arrangement of 1555 . 
There were in all 57 of these surgeons at a salary of 1 shilling per diem for 
infantry service and 2s. for cavalry. In the army mobilized to repel the 
Armada (1588), this had been raised to Is. 6d. daily, being sometimes 
supplemented by a stoppage out of the soldier's pay of 2d. monthly, the 
origin of "hospital funds. "'^ 

In Italy the different city-republics — Florence, Venice, Naples, 
Ferrara, Verona — had, from the 13th century on, a small surgical per- 
sonnel attached to their armies, usually 2 surgeons at a salary of 40 
soldi daily, while 40 galleys of the Genoese Navy had one barber and 



'Heizmann: op. cit., 282. 

1' Brunner: op. cit , 11-15. 

" \ A. Gore: op. cii., 32-41. Brunner, 15-17. 



Sixteenth Century 105 

an assistant barber for their complement of 210 men each (1337). 
Italian military surgeons of higher caste were later prominent as author- 
ities on gunshot wounds. '^ 

In Spain the tradition of ambulance and field hospital service, 
established by Isabella, appears to have been kept up, and the infantry 
regiments (tercios de infanieria) of the armies of Charles V had each a 
physician and a surgeon at monthly salaries of 15 and 12 escudos re- 
spectively. Toward the end of the 16th century a stationary military 
hospital was erected at Pamplona by Captain General Gonzaga Colona. 
The Invincible Armada (1588) had a hospital-ship, but its history was 
swallowed up in the destruction of that fleet. ^^ 

The Siege of Metz 

As a sidelight on military sanitation in the period, Heizmann has 
rightly signalized the defense of Metz (October 20 — December 26, 1552) 
as the high- water mark of medico-military administration in the 16th 
century.^* 

He points out that in the 16th century the proportion of sieges to battles was 2:1, 
due to the new element of heavy artillery, which forced troops to seek shelter within the 
ramparts of towns. Of 57 besieged towns Heizmann notes that "24 were carried by 
assault, 20 capitulated and 13 were relieved or abandoned." In other words, famine and 
disease had as much to do with results as military science. Although the lessons learned 
by the mediaeval peoples about Mosaic hygiene, the doctrine of "eight" communicable 
diseases and the isolation of possible carriers had not been forgotten, the memoirs of the 
time teem with recitals of great suffering and high mortality from dirt, disease and neglect. 
Why.' The only answer is perhaps that "man is an animal who is fain to lie in the unclean 
straw of his intellectual habits." Medico-military administration, as a definitive purpose- 
ful mechanism to force commands and individual units to keep themselves and their 
surroundings clean, was almost non-existent and its perfection had to wait upon the 
advent of Pasteur, Koch and Lister, from whom came the. newer concept that sanitation 
is personal or community asepsis. 

Prior to the siege of Metz, the armies of France, which had captured Toul, Metz, and 
Verdun, had become deplorably weakened by famine, due to the fact that the troops were 
outnumbered by their camp followers, who loaded the supply wagons with useless plunder, 
while reckless drinking of suspicious water caused "great diseases, pleurisies and fevers." 
Confronting the besieged town was the army of Charles V, consisting of 14 regiments 
(143 companies) of Landesknechte, with the rudimentary medical establishment described 
by Fronsperger, and an additional force of 120,000 Spanish and Italian companies, cavalry 
and pioneers, with 140 pieces of artillery. Opposing this gigantic army, twice the size of 
any other for more than a hundred years, the Duke of Guise had within the walls of Metz 
only 12 companies of infantry (4,600 men), 444 horse and 920 gendarmes. Yet so ably 
was the defense of the town conducted that in 65 days the besieging armies began their 
retreat on December 26, 1552. Guise had made the most elaborate preparations by 
purchasing animals, storing provisions, razing superfluous structures, expelling useless 



"Brunner: op. cil., 17-18. 
" BruDner: op. cil., 19-2] . 
"Heizmann: op. cil., 281-287. 



106 History of ^Military Medicine 

persons, classifying all others according to industrial capacity and devising effective 
sanitary measures. Soldiers sick with communicable diseases were isolated at once; 
the wounded or sick were taken immediately to hospital; barber surgeons were provided 
with money to obtain materiel for wound-treatment; pioneers were ordered to remove 
all filth and carrion and to keep the streets always clean. The supply list, as given by 
Pare, was lavish and rations were carefully doled out toward the end of the siege. Pare 
himself was the leading spirit of the medical personnel and through his big humanity 
the wounded soldier for the first time in history received attention from the body-physi- 
cians of nobles. Prisoners of war were treated with great consideration and, indeed, 
brought epidemic typhus into Metz after the raising of the siege. The besieging armies 
suffered enormoush' from the bitter cold, lack of food and clothing, frostbite, dysentery, 
scurvy and tj-phus fever, losing in all some 20,000 men. The retreat was hurried and 
in such bad order that the dead were left un buried and many of the sick and wounded 
were abandoned. These were collected and sent to hospital by Guise, while Alba was 
notified by a trumpeter that a safe conduct and water transportation would be granted 
to those conducting disabled prisoners to Thionville. 

"The defense of Metz," says Heizmann, "became the marvel of Europe; it, without, 
doubt, saved France from destruction, and, in many ways, besides political, its effects 
were lasting. Wounded soldiers were afterwards better treated, as at the siege of Thion- 
ville, 1558, and after the capture of Havre, 1563, when the project of an Invalides originated 
with the Queen Mother, though it was not carried out for many years. The humanity 
of Guise towards both well and sick was remembered at the siege of Therouanne, 1553, 
by the Spanish, who, on being reminded of it by the French, courteously saved all prisoners, 
says Brantome. After this the custom of massacring prisoners who were not reserved 
for ransom, gradually declined, and this was the germ from which arose the spirit that 
culminated, in a little over 300 years, in the articles of the Geneva Convention." 

Battle Losses up to the 17 ih Century 

As Frolich observes,'* reliable figures of battle losses in the Middle Ages are scarce, 
doubtless for the reason that, in the unsettled condition of times, few counts were taken 
and few people were competent to handle statistics. The losses among the Northern 
barbarians were probably tremendous. When Aetius defeated Attila in 451, the latter 
lost 160,000 — 300,000 out of a horde of 700,000. According to Procopius the wars 
between the Ostrogoths and Byzantines occasioned the destruction of over 15 million 
men. At Fontenay (841) 100,000 Franks were killed. The Hungarians, defeated by 
Henry I at Merseburg in 933, lost 80,000. The Crusades occasioned the destruction of 
three million (two million Europeans) in 194 years. When Rudolf of Hapsburg defeated 
the Bohemian King Ottokar in 1278 some 14,000 were slain. At the battle of the Spurs 
(1302) 1,200 French knights were killed. At Crecy (1346) the losses were 2,500 nobles, 
4,000 horsemen and 30,000 soldiers.'* The Mongol invaders, from Gengis Khan (1214) 
to Tamerlane (1369-1405), devastated vast regions and destroyed whole cities and their 
populations, sweeping from Manchuria to Liegnitz (Silesia) in 1235-41. During the 
contests among the mediaeval Italian cities there were a number of droll battles with 
no casualties whatever, due to the protective efficiency of heavy plate armor. Cortez 
in Mexico lost only 50 out of his 400 men during 1519-20, but some 4,300 out of 8,000 on 
his march to the coast (1520); he destroyed 200,000 city Mexicans in 1521. During the 
Peasants' War (1523-25) 16,000 were killed in Thuringia alone, and 7,500 at Franken- 
hausen (1525). At the massacre of St. Bartholomew (August 24, 1572) 30,000 people 



"Frolich: Ztschr. f. Krankenpflege. Berl., 1896. XVIII. 45. 
>« Frolich: Ibid.. 66-67. 



Sixteenth Century 107 

were slaughtered. At St. Jakob de Birs (1444) 1,300 of the 1,500 Swiss Confederates 
were killed and iJOO wounded, while the Armagnacs lost 2,200 killed and 400 wounded. 
At Grandson (1476) 1,000 Burgundians were destroyed; the Swiss mortality is not known, 
but the records show 400 wounded. At Murten (1476) 14,000 Burgundians were killed, 
while the Swiss lost 500 and many wounded. At Frastenz (1499) 3,000 Swabians were 
killed and 1,300 drowned; the Swiss records show only 12 killed and 60 woundedv which 
is a strain upon our credulity. In the Italian campaign of 1500-29 1,500 Swiss were 
killed and 1,500 wounded at Novara (1513) out of an army of 5,000, while 8,000 of the 
enemy were slain; at Marignano (1515) the Swiss army of 24,000 lost 6-7,000 killed, and 
1,500 wounded, the French about the same number. At Pavia (1524) the Swiss lost 
6.000.1' 

Epidemic Diseases 

In the 16th century small-pox, measles, typhus fever, yellow-fever, diphtheria, 
whooping cough, influenza, lead poisoning and ergotism, began to make their appearance 
in epidemic form, for the first time, as records go, and of these typhus fever, small pox 
and the various modes of influenza were the principal scourges of camps. Small pox, 
measles and scurvy were mainly rampant in the Germanic and Scandinavian countries. 
Yellow fever was confined to the West Indies. Typhus fever broke out among the Spanish 
troops after the siege of Granada (1489), where it was called tahardiglo (the red coat). 
It became epidemic in Italy in 1505 and 1524-30 and was first described by Fracastorius 
(1530), and in Mexico by Francesco Bravo (1570). The so-called Hungarian disease 
{morbus Hungaricus), which spread all over Europe in 1501 and 1505, was probably typhus 
fever, and was a formidable menace of armies. The so-called epidemic of syphilis at the 
"siege" of Naples (1495) has been shown by Sudhoff to have been, in reality, typhoid 
fever. Diphtheria, described by Schedel in 1492, was six times epidemic in Spain (1581— 
1600) where it was described by native writers as garrotillo, and reached Italy in 1618. 
Whooping cough was first described by Guillaume Baillou in 1578. The various forms 
of ergotism were some of them modes of influenza, and Crookshank has shown that the 
variety known as Kriebelkrankheit was, in all probability, encephalitis lethargica. 

Prostitution and Syphilis in Armies^^ 

In the armies of ancient times promiscuous sexual relations with 
attractive female harp and fiute-players and slaves were common and 
commonplace. As reflected in Homer, Athenaeus, Lucian, Plautus 
(Miles Gloriosns) and other writers of antiquity, the attitude of the 
Greeks, Romans and Asiatic peoples toward such matters was that of 
later continental Europe, which needs no further qualification or dis- 
cussion here. In the Anabasis (IV, 3; VI, 1) Xenophon refers to the 
horde of hetairae who accompanied the Ten Thousand on their retreat 
after the battle of Cunaxa (401), and the concern which the troops dis- 
played for their safety. Philip of Macedon, however, exhibited no such 
tolerance and his example was followed by his son, Alexander the Great, 
up to his entry into Babylon, when his system of restraint broke down, 
and his own end was the consequence of reckless and imbecile dissipa- 



"Brunner: op. cil., 7:5-74. 

" For an exhaustive account of this matter, see W. Haberling: Has Dirnenwesen in den Heeren und 
seine Bekampfung. Zlschr. f. Bekampf d. Geschlechtskr., I.eipz., 1914, XV. 63; 103; 143; 169; 312; 323. 



108 History of Military Medicine 

tion. In the Roman armies women were not tolerated in the camps 
before the time of Septimius Severus (193-211 A.D.), who permitted the 
soldiers to live with housekeepers {focariae)}^ Soldiers were not per- 
mitted to marry while on military duty, but for this very reason the 
entry of soldiers into distant towns, or into Rome after a campaign, was 
followed by general relaxation of morals; and as Mommsen shrewdly 
observes, this laxity was tolerated and winked at by the Roman author- 
ities as relieving the army of the expense of caring for children and 
other incidents of the married state. In the 4th century the newer 
privilege of a wife or housekeeper and children was continued, as re- 
corded in the Theodosian Codex (VII, 3, 6), but they were not permitted 
in camp, except as a special privilege (VII, 1, 3). During the Middle 
Ages the Crusades and other military expeditions were usually fol- 
lowed by great swarms of women, in spite of regulations to the contrary, 
and military orders cutting down the number were made solely for 
economic reasons, viz., to limit the number of mouths to feed in camp. 
In the mercenary armies of the 15th and 16th centuries, the late Roman 
practice of tolerating focariae was revived among the Lnndesknechte. 
These female camp-followers {M arketenderinnen) lived with the troops, 
bore them children, did nimble shilling business in doling out wine, and 
functioned generally as cooks, housekeepers, sempstresses and nurses 
for the sick and wounded. On the march these poor women were 
veritable beasts of burden, carrying on their backs all the soldier's 
luggage, as well as his illegitimate infants. Blows and curses were their 
portion; if not constantly employed in collecting firewood and other 
chores, and they were frequently fought for and exchanged like slaves. 
As depicted in the prologue to Schiller's Wallenstein, the attitude of 
the wandering Landeshnechte toward these women was one of broad, 
humorous toleration. All this was to take on a different aspect 
through the introduction of a new factor, viz., the advent of syphilis. 
Where syphilis came from, no one knows. The most rational solution 
of its mysterious apparition in the Middle x\ges is that of Professor 
Sudhoff.^" There was no demonstrable s^^philis in prehistoric times, 
nor in antiquity, and it is not mentioned by Dante, Chaucer or Boccaccio, 
all keen observers of the life around them. But Sydenham, with re- 
markable insight, pronounced European syphilis to be a modified West 
African yaws, and Sudhoff believes that it existed in Europe in the form 
of a mild endemic spirochaetosis as early as the 12th centurj', if not before. 
This view is not unreasonable, since the spirochaetae, of whatever kind, 

'• Focariae, literally, guardians of the hearth or fire-makers. 

'"See SudholT: Graphische und typographische Ersllinge der Syphilis, Leipzig, 1912; Aus der 
Friihgeschichte der Syphilis, Leipzig, 1912; Mai franzoso in Italien, Giessen, 1912: and his summary 
of the whole matter in Bull. Med. History Soc., Chicago, 1917, II, 15; 24. 



Sixteenth Century 109 

are, in all probability, parasites of tropical provenance, and the Arabian 
physicians, in Asia and Africa, were the first to use mercurial ointment 
for a mysterious group of cutaneous eruptions which were confused 
with scabies and leprosy. As the successful exhibition of quinine diag- 
noses most varieties of malarial infection, so the cleaning up of these 
eruptions by mercury points to lues venerea. This inunction treatment 
became common practice among the Salernitan and later surgeons 
long before the alleged importation of syphilis by Columbus' sailors in 
1493. Probably before 1275,^^ Saliceto had declared chancre to be 
due to coitus cum meretrice, and even recommended a prophylactic 
vinegar solution (cblutio cum aqua frigida et roratio loci cum aceto). 
To the outcast barber surgeons of the 12th-14th centuries, who were 
the natural physicians and familiars of the prostitutes of the time, 
the disease was variously kno^m as scabies grossa, variola grossa, grosse 
verole, gros vial and mal franzoso. In 1463 a courtesan of Dijon testified 
in court that she had kept off an unwelcome suitor by stating that she 
was sick with the gros vial. The alleged outbreak of syphilis among 
the troops at the siege of Naples (1495) is held by Sudhoff to have been 
an epidemic of typhoid or paratyphoid infection, and two months 
before these troops got away from Novara on October 10, 1495, syphilis 
was spreading in Germany (as shown by Emperor Maximilian's Edict 
of August 7), and had been already noted by Trithemius and B^unsch^\^g 
in 1493. While the account book of the syphilis hospital at Augsburg 
during 1497-1852, investigated by Sudhoft", shows that the disease 
never really attained epidemic proportions, there is no doubt that 
wandering soldatesca furnished a large quota of carriers. The important 
thing is that the prostitute as a carrier was recognized by the surgeon 
Saliceto before 1275, and in a French court of justice in 1463. As in the 
mediaeval ritual against leprosy, the unfortunate syphilitics were driven 
from the towns, to spread the disease elsewhere, until hospitals were 
created for them. The effects of the disease after 1495 were particularly 
malignant and loathsome, as in the syphilis of the South Seas or the 
"Black Lion" of the Peninsular War, yet in the many military orders 
restricting the number of prostitutes in camp,-^ there is no mention of 
the possibility of infection before the proposition of John of Nassau 
in 1608.-3 



'' The Cvrurgia of Saliceto, first printed at Piacenza in 1476, was begun in 1269 and completed June 
7-8, 1275 (Sudhoff). 

" For example those of Francis I (1514), Charles IX (1570) and Henry III (1379) in France, Albert 
the Pious in Belgium (1580), Maximilian II (1570) and the German Articles of War of 1524. Ilaber- 
ling, op cil., 169-173. 

"Haberling: op. cil.. 173-174 



110 History of Military Medicine 

Military Surgery in the IQth Century 
War surgery in the 16th century underwent many changes through 
the necessity of dealing with gunshot wounds.^* Gunpowder was 
described by Roger Bacon (1214-92) about the middle of the 13th cen- 
tury; canon were manufactured at Ghent a hundred years later, were 
perhaps in use at the battle of Bannockburn, (1314) and were certainly 
employed at Crecj' (1346). At the siege of Harfleur (1415) there was 
a regular service of ordnance, and in later military operations, such 
as the Hussite wars or the siege of Constantinople, the artillery played 
an effective part. Small fire-arms were at first so heavy and clumsy 
that they had to be mounted. The arquebus derived its characteristic 
bend and trigger from the cross-bow, acquired a wheel-lock in 1515, 
and through the substitution of a flint-lock for a matchlock (1671) 
was transformed into a musket. 

The first mention of gunshot wounds is to be found in the treatise 
on mihtary surgery of Heinrich von Pfolspeundt (1460), one of the 
Teutonic Ejiights. He treats mainly of arrow wounds, but describes 
the removal of powder from gunshot wounds by irrigation with human 
milk and the removal of bullets by means of the sound: 

With the sound you must lift out the little load or bullet which was propelled 
into the body by the musket, and whatever else was discharged into the wound: 

Marcello Cumano, in his Vademecum, says a few words about the 
painful character of these wounds. The next authority, in order of 
time, is the "Book of Surgery" of the Alsatian army surgeon, Hierony- 
mus Brunschwig (1497). 

Brunschwig regarded gunshot wounds as poisoned, advises removal of the poisonous 
powder by the seesaw motions of a silken seton through the sinus and extraction of the 
bullet with the forceps, after enlargement of the wound by incision or by the "wound- 
dilator." He believed in the promotion of suppuration (laudable pus) by insertion of 
bacon fat, as an aid in loosening the arrow or bullet before extraction. 

Hans von Gersdorff in his "Field Book of Wound Surgery (1517)" 
did not regard gunshot wounds as poisoned. 

He treated them by rinsing with warm hemp-seed oil, to get rid of the powder, extrac- 
tion of the bullet by various instruments, with a final dressing of "Egyptian ointment," 
compounded of honey, vinegar, verdigris and alum. GersdorfT performed amputation 
by Esmarching the limb with a constricting band, checking haemorrhage by styptic 



" For exhaustive accountsof the treatment of gunshot wounds in the 16th century, see:Th. Billroth: 
Historische Studien uber die Beurtheilung und Behandlung der Schusswunden, Berlin, 1859; E. Gurlt: 
Geschichte der Chirurgie, Berlin, 1398, II, passim: Sir. T. C. Allbutt: The Historical Relations of 
Medicine and Surgery, London, 1903, passim; \. Fossel: Mitt, der Ver. d. .\erzte in Steiermark, Graz 
1904, XLI, 161-173; N. Seun: Surg. Gynec. & Obst., Chicago, 1907, V, 613-622; C. Singer: Quart. 
Rev.. Lond.. 1916 (No. 447), 432-469; and Reinhold Winter: Ueber die Verwundungen durch Feuer- 
waffen und die dicsbeziiglichen l.«istungen der Chirurgie im 15. und 16. Jahrhundert, Breslau dis- 
sertation, 1917. 



Sixteenth Century 111 

or cautery and enclosing the stump in a bull's (or hog's) bladder. Gangrene was the 
only indication for the operation in these times. Pfolspeundt, Brunschwig, and Gersdorff 
employed the mediaeval substitute for anaesthesia, viz., inhalation of an infusion of 
opium, mandrake root, henbane, lettuce and hemlock from a "sleeping sponge." Gers- 
dorff claims to have performed one or two hundred amputations without giving any 
opium internally. He treated ankylosed joints by forcible extension with an apparatus 
called Narr (fool). Both Brunschwig and Gersdorff abound in striking illustrations of 
the surgical practice of the time, e. g., the cauterization of a wound, the first picture of 
amputation, extraction of an arrow near a battlefield, decompression of the skull by a 
special elevator, leprosy, St. Anthon}''s fire, etc. 

The view that gunshot wounds were poisoned burns was further 
upheld by the Italian surgeons Vigo and Ferri. 

Giovanni da Vigo (1460-1520) physician to Julius II, deals with the subject in his 
surgical treatise of 1514. He regards gunshot wounds as contused, scorched, or poisoned, 
and recommends treatment with boiling oil or the actual cautery, a survival of the bar- 
baric savage practice of branding which was recommended in a spurious Hippocratic 
aphorism and grafted upon European practice by the Arabian physicians. Alfonso 
Ferri (1515-95), who published the earliest work exclusively devoted to gimshot wounds 
(1552), is more moderate in his views. He observed that bits of clothing or armor driven 
into the wound may cause suppuration, advises probing for such objects, extraction of 
the bullet by a special forceps, haemostasis by underpinning the cut vessel, and evacuation 
of pus wherever found. If a lodged bullet gave no pain or other trouble, he believed in 
leaving it alone. 

In the meantime, the Swiss medical reformer, Paracelsus (1491- 
1541), had published his "Larger Woimd-Surgery " (1536) in which he 
filed a vigorous brief for simple, expectant treatment of wounds and 
general "let well enough alone " in the matter of the use of greasy salves, 
plasters, boiling oil, hot irons and other abominations. 

"Warily must the surgeon take heed not to remove or interfere with Nature's balsam 
but protect and defend it in its working and virtue. It is in the nature of flesh to possess, 
in itself, an innate balsam which healeth wounds. Every limb has its own healing in itself; 
Nature has her own doctors in every limb; wherefore every surgeon should know that it 
is not he, but Nature, that heals. What do wounds need? Nothing. Inasmuch as the 
flesh grows from within outwards, and not from without inwards, so the surgery of a 
wound is a mere defensive, to prevent Nature from suffering any accident from without, 
so that she may proceed unchecked in her operations." 

This reasoning, the essence of true Hippocratic (or aseptic) surgery 
and the intuition of a man of genius, goes to show that the contention 
about the purification of gunshot wounds by the cautery and boiling 
oil was only one phase of a larger problem, which was now to be ap- 
proached by the greatest military surgeon of the time, Ambroise Pare. 
Pare came up to Paris in 1532-3, an unlettered barber-surgeon's 
apprentice, and after three years experience as interne (compagnon 
chinirgien) at the Hotel-Dieu, divided all the rest of his long life between 
military surgery in the French armies and private practice in Paris. 



112 History of Military Medicine 

Like John Hunter he was lucky in that he had no scholastic training 
to interfere with the straightforward suretj- of his natural perceptions, 
while his hospital experience in dissecting, post-mortem work and 
practical surgery was of the best. When Pare began to make his 
reputation as a skilful surgical craftsman, Arabian doctrine, which 
divorced surgery from medicine and substituted the cautery for the 
knife, was bitterly upheld by the clerical bigots of the Paris Faculty 
(les chirurgiens de longue robe), and although Hippocrates, Hugh of 
Lucca, Theodoric of Cervia and Henri de Mondeville had taught the 
dry or aseptic wound treatment, it had been opposed by the learned 
Guy de Chauliac and all the surgeons after him, with the exception of 
Paracelsus, and eventually of Felix Wlirtz. Early in his army career, 
while surgeon to Colonel General de Montejan, on the expedition of 
Francis I to Turin (1536-7), Pare had a lesson in wound treatment that 
was destined to make history. Hear his own story: 

"Now I was at this time a fresh-water soldier; I had not yet seen wounds made by 
gunshot at the first dressing. It is true I had read in John de Vigo first Book, Of Wounds 
in General, eighth chapter, that wounds made by firearms partake of venenosity by 
reason of the powder; and for their cure he bids you cauterise them with oil of elders 
scalding hot mixed with a little treacle. And to make no mistake, before I would use the 
said oil, knowing this was to bring great pain to the patient, I asked first before I applied 
it, what the other surgeons did for the first dressing; which was to put the said oil, boiling 
well, into the wounds, with tents and setons; wherefore I took courage to do as they did. 
At last my oil ran short and I was forced instead thereof to apply a digestive made of 
the yolks of eggs, oil of roses, and turpentine. In the night I could not sleep in quiet, 
fearing some default in not cauterising, that I should find the wounded to whom I had 
not used the said oil dead from the poison of their wounds; which made me rise very early 
to visit them, where beyond my expectation I found that those to whom I had applied 
my digestive medicament had but little pain, and their wounds without inflammation or 
swelling, having rested fairly well that night; the others, to whom the boiling oil was 
used, I found feverish, with great pain and swelling about the edges of their wounds. 
Then I resolved never more to burn thus cruelly poor men with gunshot wounds. 

"While I was at Turin I found a surgeon famed above all others for his treatment of 
gunshot wounds; into whose favor I found means to insinuate myself, to have the recipe 
of his balm, as he called it, wherewith he dressed gunshot wounds. And he made me 
pay my court to him for two years, before I could possibly draw the recipe from him. In 
the end, thanks to my gifts and presents, he gave it to me; which was to boil in oil of 
lilies, young whelps just born and earth-worms prepared with Venetian turpentine. 
Then I was joyful and my heart made glad, that I had understood his remedy, which was 
like that which I had obtained by chance. 

"See how I learned to treat gunshot wounds; not by books. "^ 

While much fun has been poked at this oil-of-puppy dressing, and 
Pare never attained to the clear surgical vision of Hugh, Theodoric, and 



"From: "The Journey to Turin in 1336" in Fare's Apologia et Voyages; translated by Stephen 
Paget in his Ambroise Par6, New York, 1897, 33-35; and by F. R. Packard in his "Life and Times of 
Ambroise Par6." New York, 1921, 162-164. 



Sixteenth Century 113 

Henri, the important thing is, as Allbutt says that "from this time the 
receptive mind of Pare perceived venom and bum were figments both 
and that a gunshot wound was just a contusion or comminution Hke 
another. "2^ The most frequent response in his litany: "I dressed him; 
God healed him," and his straightforward utterances elsewhere reveal 
the forward trend of his independent thought toward the experimental 
or Hunterian ideal: 

"We should not fall asleep over the labor of the ancients, as if they knew or said 
everything." 

"You will have to render account not to the ancients but to God for your humanity 
and skill." 

Again, Fare's apphcation of the ligature of blood vessels to amputations 
was only part of his earnest desire to become a "parfait pradisour" and 
to get away from the barbarous Arabian practice of cauterizing bleeding 
wounds to stanch hemorrhage. There was nothing new in the liga- 
ture. It was knowTi to Celsus^^ and Archigenes as a commonplace pro- 
cedure in wound surgery, as well as to Roger, Roland and Yperman. 
Pare himself wrongly attributes it to Galen, and his own method was 
not a true but an indirect ligation, the ligature en masse, including some 
of the tissues around the vessel and occasioning pain and inconvenience 
to the patient. But "until the time of Pare, the surgeons, for very 
intelligible reasons, shirked the larger amputations" (Allbutt). ^^ His 
work was forward-looking and forward-moving, and his standard was 
already planted in the new territory. 

The example of Pare was followed by the Italian surgeon Bartholommeo Maggi 
(151G-52), whose treatise on gunshot wounds was published in the year of his death (1552) 
and contemporaneously with that of Ferri. He held that gunshot wounds are neither 
scorched nor poisoned, made experiments to ascertain the heat of firing in a projectile, 
substituted a milder method of promoting suppuration for Vigo's drastic treatment, 
which he condemned, and recommended the earliest possible removal of the bullet. 
Leonardo Botallo (1530), physician to Charles IX of France, in his treatise on gunshot 
wounds (1560) opposed the practice of Vigo and Ferri, regarded such lesions as contused 
wounds, which were too zealously explored, sounded, dilated and enlarged. He con- 
demned reckless dilation and in extraction, used curved sounds and shortened forceps. 
He preferred escharotics and the cautery for haemostasis, however, and was a veritable 
vampire of venesection, a pitiless bloodletter in all chronic diseases. 

High in the annals of Renaissance surgery and weIl-belo\'ed of 
medical men is the name of the Swiss army surgeon, Felix Wurtz (1518- 
75), a follower of Paracelsus in simple wound treatment. He was only 

M Allbutt: op. ciL, 8.3. 

""But if these remedies are also ineffectual in restraining the haemorrhage the bleeding vessels 
are to be taken up, and two ligatures to be applied, one on each side of the wound, and then (.the vessels) 
are to be divided between the ligatures, that they may both unite together, by anastomosing branches 
and effect an obliteration of their orifices. Celsus: De re medica. V, 26 §21. Cited by Allbutt. 

"Allbutt: op. cil.. 82. 



114 History of Military Medicine 

a wound-surgeon, had no book-learning, wrote in the vernacular, and 
never essayed the major operations. He stood for laudable pus and the 
belief in suppuration as a cleanser of wounds, but none wrote with 
more fiery eloquence in aid of clean hands and against the meddlesome 
probes, plasters, salves, poultices, tents, setons and general fingering of 
open wounds. In the surgical treatise of Wiirtz (1563) is a little pediat- 
ric tract, easily the best of the time, which is the first brief for infantile 
surgery and orthopedics. When he lifts his voice against the deforma- 
tion of infants by tight swaddling and rough handling, we sense the 
larger humanity of the Renaissance. "His heart beats so high that 
the thumping against his leathern coat is audible across the centuries."^' 

The great Provencal surgeon Pierre Franco (1503- ), driven into 
Switzerland by the Waldensian massacres, was, like Pare and Wiirtz, 
a self-educated barber, and was thus, as Allbutt says, "spared the mis- 
fortune of a speculative intellect." He was a bolder and better operator 
than Pare, and by his improvements in the technique of herniotomy, 
lithotomy, eye surgery and plastic surgery, took these procedures out 
of the hands of the strolling incisors and added new territory to the 
domain of legitimate surgery. He had been slightingly treated by Haeser 
and Gurlt, but the right judgment is that of Malgaigne — "ce beau ginie 
chirurgicale" and of Nicaise: "no surgeon made such discoveries as 
Franco; for hernia, stone and cataract he did more than Pare." 

It remains to give some brief account of the great pathbreakers of 
Renaissance medicine, three shaggy, assertive figures to whom our pro- 
fession owes much of the social position and intellectual liberty it now 
possesses. 

Paracelsus 

Aureolus Paracelsus (1493-1541), of Einsiedeln, Switzerland, a 
student of Leonicenus at Ferrara (1515), began his lectures at Basel in 
1527 by throwing the works of Galen and Avicenna into a bonfire. Of 
the astrological medicine of his time, he said: "I will throw your horo- 
scopic prognostications into Lake Pilatus." He was the essential 
reformer of Renaissance medicine, aptly styled Luther medicorum. He 
was rough of speech, coarse in invective, obscure in thought and expres- 
sion, but with such rapid flashes of insight as only true genius has, and 
popular as no other physician before him — the people's physician par 
excellence. 

Paracelsus was the founder of chemotherapy, taught that medicine and surgery are 
one (einerlcy), stood for rational wound-treatment,'" opposed witchcraft, starcraft and 



" R. W. Emerson. 

•'' For the wound-surgery of Paracelsus, see; Wolzendorff: Deutsche Ztschr. f. prakt. Med., Leipz., 
1876, III, 46; 58. 



Sixteenth Century 115 

uromancy, was the 6rst to analyze mineral waters and made real additions to the phar- 
macopoeia. He was the first to write on miners' diseases, described miner's phthisis and 
the effects of choke damp, saw gout and stone as diathetic diseases, and noted the correla- 
tion between goitre and mA'xoedema. His motto was: Experimentation controlled by 
the authoritative literature"" — a truly modern note. 

J''esaHus 

Andreas Vesalius (1514-64), born in Brussels, sometime a mili- 
tary surgeon in the armies of Charles V, was the founder of modern 
anatomy, which he first taught locally by public dissection, demonstrat- 
ing to all and sundry such knowledge of the structiu-e of the human 
body as had never been seen before; and then urbi et orbe, in his epoch- 
making treatise, the Fabrica (1543), with illustrations only bettered in 
their time by the unapproachable drawings of Leonardo da Vinci. 
This book obliterated the older Galenic anatomy of apes and swine and 
was imitated and improved upon for centuries. In the copy of the 
Fabrica in the New York Academy of Medicine, Dr. Osier wrote: 
"The greatest book ever printed, from which modern medicine dates." 
Vesalius did the only physiological experiments between Galen and 
Harvey, was a pioneer in craniology and comparative psychology, and 
an admirable clinician and pathologist. While on duty with Charles V 
he was the first to describe aneurism of the thoracic and abdominal 
aorta (1555), ^^ the most important landmark in the history of the 
condition between Galen and Pare. 

Ambroise Part (1510-90) 

He was born in the little village of Bourg Hersent (Maine) and 
lived to the age of 80, his lifetime covering the better part of his century, 
from Flodden Field to the Armada, from Luther at Worms to the battle 
of Ivry. He lived through the reigns of seven French monarchs and 
of three Holy Roman Emperors (Maximilian, Charles V, and Philip H). 
Through this long life he managed to remain honest, firm, upright, 
humane and essentially sweet-tempered to the end, steering clear, as 
an impersonal phj^sician and soldier,^^ from the intrigues of courts and 
the fanatical hatreds of religious sects. Although probably a Huguenot, 
his life was saved by the king at St. Bartholomew, and four months 
before his death we find him pleading successfully with the Archbishop 
of Lyon for the welfare of the besieged people of Paris. He invented 
many surgical instruments, introduced artificial limbs and eyes, the 



•' "Experimenta ac ratio auctorum loco mihi suffragantur." Cited by Sudhoff. 

" For an account of which, see: A. N. Tasker: Mil. Surgeon, Wash., 1922, L. 338-342. 

"That Par6 was treated as the equivalent of an officer in campaign is evident from the manner in 
which he was consulted by monarchs and commanders in regard to military operations, e.g., at the 
defense of Hesdin (1553). 



116 History of Military Medicine 

truss and implantation of the teeth, reintroduced massage and podalic 
version, described pyaemia, the effects of prostatic hypertrophy and 
fracture of the neck of the femur; saw flies as possible carriers of wound- 
infection and was the first to suggest the syphilitic origin of aneurism. 
But these are only details that went to the making of a great all-round 
surgeon. His collective works, the apple of his eye, are a curious 
mixture of sound sense and surgical genius with a specious parade of 
scholarship which may be charged up to the mysterious pion who prob- 
ably embellished his writings for him.*^ For this Pare was persecuted 
by a bigot of the Paris Faculty, who wanted to stop the publication 
of his book, but serene in the support and countenance of the king, he 
flaps his adversary with bladders as mon petit maistre and, with the 
urbanity of his race, admonishes him to "quit his animosities and 
treat more kindly le bon vieillard." This phrase goes to the very heart 
of the matter. Pare is the greatest of military surgeons, just as Larrey 
and Letterman are in a manner the greatest of medical officers, through 
his ability, his large humanity and insight. Read his Apologia et 
Voyages and you will see for the first time in military history a medical 
vassal of great captains going out of his way to succor the ordinary 
wounded soldier, as at Perpignan (1543) or Boulogne (1545) or on the 
march through Germany (1552). Early in his career, at Turin (1536), 
Pare had seen an old sergeant cut the throats of three helpless wounded 
men, "gently and without malice," to put them out of misery. The 
episode appears to have affected him as profoundly as the boiling oil 
and red hot irons applied to wounds. The age in which he lived was 
one in which extravagant generosity touched hands with incredible 
meanness and jocund brutality. Courts assemble to view the autos- 
de-fe. High-born ladies laughingly inspect the corpses after St. Barthol- 
omew for a reason not mentionable to ears polite. The brave Servetus 
is tortured to death in flaming fire for a quibble about theological verbi- 
age, while the crowd looks on in sheep-like docility and gives no sign. 
The type is that of Hewlett's Bothwell leaning over the ship's taffrail 
and bawling at the perishing sailors : " Sooner you than me, you drowning 
swine!" In the bloody period in which he lived, a period in which people 
were less sensitive about murder and adultery than about differences 



3* No reQection is cast upon Pare in this assertion. In the period following the Revival of Learning, 
allusions to the Greek and Roman writers were as much in everybody's mouth as our small talk about 
classical music after symphony concerts, and Fare's actual knowledge of ancient medicine was, in his 
long life, as real and effective as Shakespeare's or Beethoven's knowledge of Plutarch's Lives. But it 
was the fashion of his time tostuffmedical treatises with a footless show of erudition and he followed the 
line of least resistance. The apparent swagger in his writings is the expansive self assertion of the 
Renaissance people, which we find alike in Luther, Knox, \'esalius, Paracelsus, Brantome, the Eliza- 
bethan dramatists and even Montaigne. 



Sixteenth Century 117 

in religious beliefs, the sane, humane figure of Pare towers above his 
time and environment like some great seamark in an ocean storm. 
In the words of Street er: 

"Quiet sessions with Pare leave us with the inevitable conviction that the ultimate 
ground for the safety and permanence of our human world lies in character — the character 
of plain, brave men like Pare. Our rogueries, frauds, cozens and delays cannot cover the 
fact that the central glory of the universe is character. Now, may we ask, what is the 
role of character in the art and mystery of medicine.' What it has always been — that 
which redeems from decay." 



CHAPTER VI 
The Seventeenth Century 

Through the 16th and 17th centuries the spirit of individuahsm 
gained complete ascendancy and collectivism went into decline. The 
17th century was an age of extraordinary activity in science, literature 
and art, while practice of medicine, hospital management, and organ- 
ized care of the sick and wounded sank to a very low level. The centric 
achievement of 17th century medicine was the demonstration of the 
circulation of the blood by William Harvey in 1616 and his publication 
of the same in 1628. This great event, the starting point of modern 
experimental physiology, was accompanied by an impressive array of 
anatomical discoveries, each of physiological significance and led to 
the solution of the main elements in the problem of the physiology of 
respiration by a number of English chemists. Descartes outlined the 
theory of reflex action. The principles of the physiology of vision were 
elucidated by astronomers and mathematicians. The only work in the 
physiology of digestion before the time of Beaumont was accomplished 
by Peyer, Brunner and de Graaf (pancreatic and biliary fistulae). 
In the hands of Kircher, Hooke, Leeuwenhoek and Malplghi, the 
microscope became a powerful aid to medical science. The founda- 
tions of medical jurisprudence and of vital statistics were well and 
truly laid and internal medicine, while generally backward, was eventu- 
ally associated with such great names as Sydenham, Willis and Francis- 
cus Sylvius. Many new diseases were described. The relation between 
typhus fever and pediculosis was noted in army camps by Tobias Cober 
in 1606. Some of the greatest medical men of this century, such as 
Harvey, Descartes, Willis, Sydenham, Wiseman and Purmann, served 
in armies. In 1633 Stephen Bradwell published the first book on first 
aid in sudden accidents.' Some 30 books on contagious diseases in 
armies were published, the most notable being the Medicina Militaris 
(1620) by Raimund Minderer (of spiritus Mindereri). 

The wars of the period were the religious wars already mentioned, 
the English Parliamentary Wars and the struggle between the Dutch and 



' S. Bradwell: Helps for Suddain Accidents endangering Life. London, 1633. It treats of poison- 
ing, including that from mushrooms and shellfish, venomous bites and stings, falls from high places 
strangling, drowning, suffocation, choking, scalding, burns, and foreign bodies in the throat or gastro 
intestinal tract, including snakes and worms. The directions are quaint but practical. A similar 
tract of 23 chapters, prepared by Daniel Ludwig (1625-80) at the instance of Duke Ernst I of Saxe- 
Gotha, and published in 1635, is described by Toply as an inferior production. (Militararzt, \\ien. 
1886, XX, ?09-2U.) 

118 



Sevexteexth Century 119 

the English on the seas for the control of commerce, in particular of the 
drufr trade. 

This lucrative phase of maritime activity was a natural outcome of contact with the 
East through the Crusades and its origins are intimately connected with the facts set 
forth in Mr. Wells' chapter: "Land Ways give place to Sea Ways." In the Middle Ages 
the Eastern drug trade was in the hands of the Venetian Republic, which already con- 
trolled the Mediterranean transport service during the Crusades. When Vasco de Gama 
doubled the Cape in 1498, the Portuguese gained their opportunity and Lisbon became 
the central mart for drugs and spices during the 16th century. After 1596 the Dutch, 
who controlled the maritime freight service between Northern and Southern Europe, 
gained the jealously guarded secret of the sea-route to the East, through the publication 
of Linschoten's travels, and once they had worsted the Portuguese in naval warfare, 
resorted to every device to monopolize the clove and nutmeg. As Motley observed, the 
world's destiny seemed to hang upon "the growth of a particular gillyflower." The clash 
between the Dutch and the English began about 1622-23, but the English had already 
gained a decisive foothold in the Indies through the chartering of the British East India 
Company on December 31, 1600. 

The military medicine of the period shows no great advance over 
that of the 16th century due to the rigid divorce between medicine 
and surgery started by Galen, maintained by the Arabians, standard- 
ized by the ecclesiastical interdictions of the Middle Ages, and now 
become codified custom. The bitter rivalries between physicians, 
surgeons and barbers continued, and while the physician had the best 
of it, styling himself a medicus purus, he was usually as Moliere has 
represented him, a sterile pedant and coxcomb. In England internal 
medicine was nothing to speak of before the time of Sydenham (1624-89). 
As always happens in an age in which scientific medicine is ardently 
followed by the elect, the folk-medicine of the period became more 
ludicrous and contemptible than that of primitive man. The therapeu- 
tic devices of the 17th century reveal a distinct backward trend in 
internal medicine. The pharmacopoeias of the time were very aptly 
styled "filth-pharmacopoeias," as being made up of the most nauseating 
and loathsome ingredients, usually compounded from the parts of 
difTerent animals. Writers on military medicine are singularly reticent 
as to the contents of the vaunted field medical chests of the period, some 
of which contained no less than 284 remedies, including oils of vipers and 
angle-worms, beetles, ear-wigs, powdered mummy, etc.^ Mme. de 



'A field-cliest devised by Muralt for the Ravarian artillery in the Turkish campaign of 1688 is 
described by J. Schuster (Deutsche mil.-arzll. Ztschr., Berl., 1916, XLV, 123-131). It weighed 320 
pounds and contained 30 surgical instruments and materiel, with 197 remedies, including 3 pounds 
of theriac (an opiate antidote of 64 ingredients), mithridate (49 ingredients), tincture of bezoar, Pan- 
Doaian powder (mostly red sandal-wood), piilvis ad casum (i. e., for any emergency, containing rhubarb, 
terra sii/illala, palm-juice, spermaceti and mummy dust), scorpion oil, rainworm oil, zinc oxide, Vigo's 
plaster of frog-spawn and mercury, human fat, dog's fat, rhubarb, jalap, aloes, senna, tartar emetic, 
Peruvian bark, mercurials, sugar of lead, alum, guaiac, sassafras, squills, cautharidcs, hartshorn, sal 
ammoniac, camphor, opium, etc. 



120 History of Military Medicine 

Sevigne was enthusiastic about urine as a remedy. Sir Kenelm 
Digby's "sympathetic powder" for heaUng wounds at a distance, and 
the "weapon-salve" appHed to the weapon instead of the wound, were 
employed everywhere with portentous seriousness, showing the dis- 
continuity of the popular mind in medicine, then as now. The worth- 
while surgeons of the entire century — Wiseman, Fabry of Hilden, 
Purmann, Scultetus, Zambeccari — can be counted on the fingers of one 
hand. Surgical instruction was so poor that, as all the authorities of 
the time opined, war was the only field in which it could be learned. 
The only other alternative for the apprentice, to ship as surgeon on a 
whaling vessel to Greenland, was worse than nothing. Difficult opera- 
tions were seldom essayed as endangering the surgeon's personal 
welfare or entailing the loss of his practice. The surgery of the people 
and of the common soldier remained in the hands of the barber, the 
bath-keeper, the strolling fly-by-night quack who attended fairs, and 
to these was now added the grim figure of the executioner or headsman, 
whose skill in breaking bones on wheels and other phases of judicial 
torture^ was supposed to render him expert in bone-setting. Over all 
these, the scholastic physician, of pedantic, pompous type, lorded it 
with becoming dignity. In France exemplary respect for "the physi- 
cian, our masters" was enjoined upon the surgeon, who did not attain 
his independence from physicians and barbers until 1743. In Prussia 
public examinations to test the fitness of surgeons were not required 
prior to the first medical edict of Mark Brandenburg (1685). The 
arbitrary separation of medicine from surgery was rigidly enforced in 
the field, the physician attending to internal complaints while wounds 
were left to the barber. The ultimate practice of having Physicians 
General and Surgeons General at one and the same time could only 
result in decentralized administration, both in the armies of Frederick 
and Washington. 

In the 17th century the mediaeval aspiration toward nationhood 
had become accomplished fact and standing or national armies existed in 
France, Austria, Sweden, Russia and the Mark or Electorate of Branden- 
burg (later Prussia). The main advances in military science were the 
subdivision of large masses of troops into tactical units or batallions 
of 600-800 men each, introduced by Gustavus Adolphus, the gradual 
substitution of musketry for pikes and halberds, with more efficient 
artillery. In consequence of these changes battle lines were spread over 



' Torture as a mode of compulsion or punishment was not abolished in Prussia until 1740, in Saxony 
until 1770, in Austria until 1776, in Holland until 1798. In other countries, it died out indefinitely, 
never existing in Sweden, where it was expressly forbidden in 1734. For the many refinements of 
cruelty which were sanctioned in the name of '"judicial torture." see the illustrations in R. Quanter: 
Die Leibes-und Lebensslrafen bei alien \'6lkern. Dresden. 1901. 



Seventeenth Century 121 

wider surfaces by deploying troops in thin, open-order arrangements. 
Under Gustavus Adolphus the soldier's burden of heavy armor and 
equipment was much reduced in weight, the manual of arms was highly 
specialized and the cavalry arm regained its prestige as "squadrons of 
horse" (Reiterei), armed with swords and pistols instead of lances. 
The French inventions of the flint-musket (1635) and the bayonet 
(1640) further influenced the fortunes of war. Gustavus Adolphus was 
more forward than any other military leader of the time in proper con- 
sideration for the sanitary welfare and medical treatment of his men, 
and was the first to uniform his regiments completely. In this period 
the army surgeon acquired a definite uniform, destined to become the 
distinctive costume of the practising physician in the 18th century, 
consisting of a tight-waisted justaucorps coat reaching to the knees, 
with the usual small clothes, stockings and buckled shoes. Specimens 
of these coats were exhibited at Dresden in 1911,^ and they are fre- 
quently depicted in the surgical treatises of Purmann and Heister. 

The wars of the 17th century, in particular the Thirty Years War 
(1618-48) and those waged by Louis Quatorze (1672-97) were of ex- 
traordinary duration. In considering their effects upon military 
medicine it will be convenient to arrange the scattered material under 
the different countries. 

France^ 

The ambulance hospital established at the siege of Amiens by an edict of Sully, minister 
of Henri IV (November 25, 1597), had been preceded in order of time, by the field tents 
or camp hospitals of Queen Isabella (14S7), a camp hospital at the siege of Rouen (1591), 
and others, but it was so well managed by Pigray, a pupil of Pare, that even officers pre- 
ferred to be treated in it (Heizmann). It was, moreover, the starting point of a number 
of attempts on the part of Henri IV, Louis XIII and their ministers, to improve the 
condition of the wounded and disabled soldier by the foundation of permanent institu- 
tions. As long as the siege of Amiens lasted, Sully himself went there regularly each 
month with a fund of 1,500,000 crowns, a goodly portion of which was destined for the 
hospital, frequented mainly by officers and "persons of quality," while provisions were 
made for the care of the wounded in neighboring villages. By edicts of Henri IV (1604- 
11) the Maison de la Charite chretienne, founded in Paris by Nicolas Houel, was opened 
to destitute and disabled soldiers, with funds and administrative board, and this privilege 
was further extended to widows and orphans of soldiers killed in battle; but after the king's 
death in 1610 the arrangement went into abeyance through lack of funds. Edicts of 
Louis XIII (1011-29) revived the ancient Carlovingian droit d'oblaf, in virtue of which 
disabled and infirm officers and soldiers were assigned as lay brothers {freres lais) to 
monasteries, where they eked out their existence as sweeps, gardeners and bell-ringers. 
In January, 1629 an ordinance of Richelieu established the first stationary hospitals in 
the rear of armies in the field, and a state document of 1630 demonstrates the existence of 
one of these base hospitals at Pignerol, with adequate medical and surgical personnel. 

«Sudhoff: Dresden Catalogue, 1911, 319. 

'Cabanfes; Chirurgiens et blesses k Iravera I'histoire. Paris, 1918, 146-200. Heizmann: Ann. 
Med. History, N. Y., 1916-17. I, 287-292. 



122 History of Military Medicine 

Three years before Richelieu had improved field hospital service at the siege of Rochelle 
(1627) by the addition of personnel to insure the distribution of soups and medicine to 
all who could or would not seek assistance. In 1638 Richelieu published another ordi- 
nance providing for priests and cooks to look after the sustenance of the sick and wounded 
who would not go to the field or sedentary hospitals. By 1633 he had advanced to the 
idea of founding a disabled soldier's home or Maison des inralides, construction of which 
was begun in August, 1635. But after dedication of the scaffolding with great eclat 
on September 27 of the same year, the project was suddenly abandoned and came to 
nothing before the definitive opening in 1676. The disabled invalides, who had paraded 
with great pomp on this occasion, were sent back to their monasteries to resume the 
pensioned status of the oblat. During the reign of Louis XIV, through the good offices 
of Cardinal Mazarin, Le Tellier, the Secretary of State (1677-85) and his successor Sublet 
de Noyers (1636-43), funds were frequently found for assisting the wounded in the field; 
military hospitals were established at Arras, Calais, Dunkirk, Perpignan and elsewhere, 
and the administration of the regimental and base hospitals, formerly in ecclesiastical 
hands, was placed under an inlendant. Pensions of 30-50 livres were granted to disabled 
soldiers; officers received 300-400 livres. But, in spite of these remarkable advances, 
the condition of the wounded in the field and in hospital left much to be desired, while 
the streets of Paris and the larger towns swarmed with lame, crippled, infirm and mutilated 
soldiers, whose physical status, as depicted in the etchings of Callot, was that of squalid 
beggary. The poor construction and administration of the military and civil hospitals, 
which consisted of little else than spacious halls in which the squalid patients were crowded 
three in a bed, made them nests of infection, held out little attraction to those who could 
get along without them and engendered the well-considered horror of hospitals which 
persisted until very recent times. The funds disbursed for care of the wounded were 
frequently embezzled by officers bent on libertinage in the capital, and many of the 
invalided preferred vagabondage to seclusion in convents. The increasing numbers of 
disabled mendicants in the capitol finally induced Louis XIV to carry forward the old 
plan of a Hotel royal des Invalides, which was at length established by an edict of April, 
1674, with the Secretary of State for War as Director. The institution was opened in 
1676, with the inscription " Laeso et Inricto Milite" upon the imposing facade, but even 
here the inmates are described by Vauban, Langle and other observing spirits as poorly 
clad, ill-nourished, crowded two in a bed, and a general eyesore to the public. None the 
less, these developments are of the utmost importance as precursors of the final stage in 
which care of the wounded and disabled became a permanent function of government. 
The base hospitals led to the establishment of permanent garrison and port (naval) hos- 
pitals in France, but nowhere else, and after 1666, Vauban designated places for hospitals 
in all captured towns of Alsace and Flanders which he was called upon to fortify. In 
1667 Louis XIV held a conference with Turbiere, Bienaise and Gayant on improving the 
medical service of the army in Flanders, to which these men, the ablest surgeons then in 
Paris, were assigned, Turbiere with the title of "Surgeon Major Consultant of Camps and 
Armies." The medical personnel of the army had increased to the extent that at the battle 
of Seneffe (1674) the intendant Robert was able to assign 230 military surgeons to three 
villages, with nurses and material adequate for the care of large numbers of wounded. 
In 1683 it was ordered that the sick be lodged before officers in campaign, 

Siceden^ 

Gustavus Vasa (1523-60) created the first standing army for his country, made up of 
regiments of 12 companies (400-500 men), each company being provided with a barber 

' E. Knorr: Ueber Entwickeliing und Gestaltung des Heeres-Saiiilatjiweseiis, Hannover, 1880. 
6.52—660. Heizmann; op. cit., 292-294. 



Seventeenth Century 123 

surgeon or "beard-shearer" (Bardskdrare). At the same time a navy was started 
with a barber-surgeon for each ship. These barbers were organized into definite guilds, 
pledged to furnish medical personnel to the army in time of war. In 1613 each regiment 
of infantry had two barbers, each regiment of cavalry one. By an order of February 15, 
1614 the personnel of an infantry regiment was increased to 3 company barbers and 
one regimental barber, at salaries which varied greatly with the times, viz., 8 thaler 
monthly in 1614, 48-80 thaler monthly m 1625. Under Charles IX (1611) a regimental 
barber received 40 thaler annually and 20 thaler for a uniform. Under Gustavus Adolphus 
he received 150 thaler annually, 50 thaler for clothing and abundant supplies. In 1625, 
one of the Swedish regiments of cavalry had 16 companies of 125 horse each, with 4 
regimental barbers at 30 thaler monthly and 16 company barbers at 15 thaler monthly. 
In the armies of Gustavus Adolphus each regiment had at least 4 barber surgeons. 

The Thirty Years War began with the battle on White Hill near Prague (November 20, 
1620) and in the course of five years was transferred to North Germany, where Tilly and 
Wallenstein gained ascendancy at the battle of Barenburg (1626). Toward the end of 
June 1630 Gustavus landed an army of 13,242 men in Germany, 6 regiments of these 
being Scottish troops. On September 17, 1631 he defeated Tilly at Breitenfeld. The 
scene of war was then transferred to Bavaria, which was terribly ravaged by both armies. 
Gustavus was killed at the battle of Lutzen (1632). He was the greatest military genius 
of his time, and his medical arrangements were remarkable.' Each general acted as 
commissary oflScer, distributing daily rations of bread and meat. Pillaging without 
leave was punishable by death; disputes over spoils were settled by turning the plunder 
over to the "next hospital;"* civil hospitals, schools, churches and mills were exempted 
from pillage, and one-tenth of the spoils was set apart for the sick and wounded in hos- 
pital. The sick and wounded were usually left in captured towns to be treated in local 
hospitals, and wagon transportation of the wounded was sometimes employed. Enemy 
wounded were gathered in camp and sent to hospitals in adjoining towns. There were 
several precursors of the Red Cross convention in the Thirty Years War, notably at the 
siege of Domitz (1631), the surrender of Magdeburg (1636) and at Garlitz (1641). In 
spite of the care and forethought of Gustavus, his armies were steadily decimated by 
dysentery, typhus fever and plague and the frightful mortality of the native population 
during the entire Thirty Years War was largely due to the spread of these diseases by 
wandering soldiery on both sides. The opposing Imperalist armies under Wallenstein 
had field-barbers at 33^ Reichstaler, ranking between muster-clerks and trumpeters or 
blacksmiths, a general field-barber being attached to the general staff. Recruiting was 
done by impressment of the lawless and worthless in towns, pay of sick soldiers was 
continued three months, "if the flag still waved;" but little is known of the arrangements 
for care of the wounded.' 

Brandenburg^'^ 
The fusion of the Mark of Brandenburg and the Duchy of Prussia under a Hohenzollern 
prince was not formally effected until 1701. In the armies of Elector George Wilhelm 
(1619-40), numbering 8,000 infantry and 2,900 riders, every regiment had a regimental 
barber and every company of infantry and cavalry a field-barber. His successor, the 
Great Elector (16-iO-88), created a standing army of 28,000-38,500 men, and increased 

' For which see. Job. Heilmann: Das Kriegswesen der Eaiserlichen und Schweden zur Zeit des 30- 
jahrigen Krieges, Leipzig «& Meissen, 1850, pp. 158, 192, 245, 269, etc., cited by K6hler. 

' Among these was the Waldstein Soldiers' House, erected by Gustavus for wounded and infirm 
soldiers and richly endowed by Queen Christiana (Heilmann, op. cit, 269). 

•See A. Kohler: Berl. klin Wochenschr., 1913, LV, 1082-1084. 

" Knorr: op. eii., 64-73. 



124 History of Military Medicine 

the medical personnel by a cornet-physician {medicus de cornuY^ and a stafif barber, both 
attached to the general staff, while troops quartered in the larger cities had also garrison- 
physicians, who treated the officers for internal diseases and devised sanitary measures 
during epidemics, and garrison-barbers, who were ordinary wound-surgeons. Dispensa- 
tion of drugs was in the hands of field-apothecaries, subordinated to a staff-apothecary. 
There were no hospitals at this time, the sick and wounded being treated in quarters. 
In the reign of Frederick I (1688-1713) the company-barbers, formerly subordinated to 
the captain of the company, became subalterns of the regimental barber. In the time of 
the Great Elector the regimental field-barber ranked between a field-clerk and a drummer 
and got 8 thaler as pay. According to Baas, a company barber got the equivalent of 
11-15 marks monthly in the infantry and 11.40 marks in the cavalry (raised to 27 marks 
in 1655). The regimental barber got 30 marks in 1638, 15 marks in 1639, 27 marks in 
1655 and 52.80 marks in 1685, while the pay of a Saxon Feldscheerer in 1613 was 33 marks 
monthly. During the Thirty Years War and after the Feldscheerer did the duties of 
regimental surgeon, regimental barber and standard bearer combined.^ The regimental 
barber had several apprentices under him, who assisted at operations along with the 
company barbers. Purmann, who was company and regimental barber in the armies of 
the Great Elector during 1667-1679, records that his regiment had 4 apprentices, the 
most liberal allotment in the whole army. As described by the writers of the time, the 
training of these apprentices was the poorest conceivable, consisting of little more than 
practice in curling wigs or trimming hair and beards. The Great Elector was, however, 
extremely solicitous about the transportation and care of the wounded. In an order 
of 1675 he censures his field-marshal, George, Prince of Anhalt Dessau, for neglecting 
this duty, and commands him to find places for receiving the wounded and to punish 
officials who did not comply with this obligation. After the battle of Fehrbellin (1675) 
he issued an order to the city commandant at Spandau (July 21) to provide three wagons 
for the wounded, with plenty of straw bedding inside, and with hoops fastened above 
and festooned with green bushes, to protect from the sun. Each of these wagons was 
commanded by a special officer. One of his marching orders, of date November 7, 1670 
states that, for the transportation of the sick, as many conveyances as necessary or pos- 
sible were to be commandeered, to be released successively as places were reached in which 
patients could be housed. An order of December 27, 1677 commands the magistrate of 
Stettin to provide not only quarters for the sick and wounded, but also medical care 
and attention. The Great Elector's hygienic ordinances for the construction of buildings 
against the pest, and for the sanitation of wells and streets (1641-60) are also progressive 
in spirit. On November 1, 1685 he instituted the Medical College of his Electorate. 

Sicitzerland}^ 

In the 17th century the military power of Switzerland sank to a low ebb, due to 
the constant internecine warfare over religious creeds and to the fact that the best of the 
manhood of the nation was emploj'ed elsewhere as mercenary soldiery. During the Thirty 
Years War the Swiss were unable to maintain neutrality and protect their frontiers from 
invasion. Their largest mobilization was that for national defence when Louis XIV 
threatened Burgundy in 1668. The muster rolls of the different cantons throughout the 
century show that each company of infantry, artillery or cavalry had a field barber, and 



"So named because attached to the cornet, a cavalry-formation, the standard-bearer of which 
had also the title and rank of "cornet." 

'2 A. Kohler: Arch. f. klin. Chir., Berl., 1914, CV, 781-784. Participation of army surgeons as 
combatants was common in the Swiss, Prussian and English armies in this period. 

" Brunner: Die Verwundeten in den Kriegen der alien Eidgenossenschaft. TUbingen, 1903, 
192-229. 



Seventeenth Century 125 

in the second half of the century, there were also regimental barbers for the larger forma- 
tions. The three regimental barbers of Zurich (1682) were experienced surgeons, includ- 
ing the city physician and chief surgeon of the city hospital. In 1683 the General 
Staff of the Bernese Army had a field physician, field barber-surgeon and field apothecary 
In the Defensionale of 1688 there is no mention of sanitary organizations for the large force 
then mobilized. The field physicians were provided with medicine chests. In 1687 
Johann von Muralt of the Zurich forces drew up directions for packing one of these chests, 
which with the rules he gives for the treatment of gunshot wounds of different viscera, are 
far superior to anything else of the period. The pay of the field barbers was 10-12 kronen 
monthl\^ The instructions for field-barbers in the War Manual of Capt. Lavater (1657) 
are taken from Fronsperger. The city accounts of the different cantons (with Feldschers) 
for the care and treatment of the wounded show liberal e.xpenditure of public moneys for 
this purpose. An extensive account of the city of Lucerne with the excutioner Balthazar 
Mengis" suggests, in its details, that this functionary was also an expert bone-setter and 
wound surgeon. 

England}^ 

In the reign of Queen Elizabeth English forces were frequently employed in 
Ireland, and during these Irish wars there was mvich hardship and depletion of personnel 
by disease, through lack of proper medical arrangements and officers. At this time 
there was "only one apothecary in all Ireland," and while Campion noted young medical 
aspirants "conning by rote the aphorisms of Hippocrates," physicians were few and far 
between. In consequence of the damp climate, the hard life in the bogs, poor food-sup- 
plies, and general bad management, epidemic dystentery, mortification of wounds, plague 
and other diseases did their work, and the royal forces were frequently so decimated that 
they were often at the mercy of their opponents. In the meantime, Irish soldiers were 
frequently employed by the English forces for service abroad. Through native brawn, 
length of limb, high spirits and unfailing courage, these Irish "kerns" and "gallowglasses" 
early demonstrated themselves to be remarkably efficient soldiery, and like the Swiss, 
were soon to be hired for this purpose all over Europe. Beyond an unprecedented raise 
in pay to £5 a week for the physician of the commander of the troops in Ireland (Lord 
Deputy Mountjoy), the disastrous results of these Irish campaigns excited little concern 
among the military authorities, probably by reason of the poor quality of medical 
personnel everywhere at this time. William Clowes, the satirist of English surgery in the 
period, writes in 1596: 

"It is most truly said there is no coine so current but hath in it some counterfeits, which 
make it suspicious, so it is there is no profession so good but hath also some counterfeits, 
which breed in it disgrace; and none so much, I suppose, as there bee in some these daies, 
that take upon them the honest title and name of traveling surgeons. . . . Therefore 
friendly reader, let this be a warning unto thee, to take heed of these unclean birds, who 
do daily abuse many worthy persons, captaines, gentlemen, masters of ships and mer- 
chants of good account, by reason of their shameless braggings and boastings of their 
great, divine, magnificent skills in physick and surgerie, wherewith they say they are 
adorned and exceed all others, under color hereof, by their fraud and subtle means. . . . 
Truly many a brave soldier and mariner hath perished, and sometimes the Generall 
and Captaines themselves." 



" Brunner: op. cil., 212-214. 

» A. A. Gore: The Story of Our Services under the Crown. London, 1879, 41-73. H. A. L. 
HoweU: J. Roy. Army Med. Corps, Lond., 1904, II, 606-737. 



126 History of Military Medicine 

The Thirty Years War drew a great many English, Scotch and Irish soldiers into 
Germany, and although these expeditions were accompanied by medical officers, these too 
suffered great privations from cold and were frequently cut off in their prime through 
the ravages of epidemic disease. The pay of medical personnel at this time was about 
6s. 8d. per diem for physicians and surgeons, 2s for "barber surgeons," 6d. daily for 
"under barber surgeons" and 3s. 4d. for apothecaries. The assignments were, 
as elsewhere, one surgeon for each troop of infantry, horse or artillery. The Crom- 
wellian forces in Ireland had an apothecary general, but were otherwise but 
indifferently supplied with medical personnel, and there was still a great scarcity 
of native Irish physicians. Petitions of army surgeons that they be dispensed 
from transplantation to Ireland as colonists are on record. Wounded officers were some- 
times carried on horse litters and sheltered in the castles of the nobility, but the lot of the 
sick and wounded soldier was undoubtedly hard. Sick and wounded Irish were frequently 
hidden in caves. Prior to this time, Charles I, to raise medical personnel for his French 
and Spanish expeditions, had, in 1626, authorized the Corporation of Surgeons of London 
to increase the pay of surgeon majors to 5s. daily (about 25s. present money) with a surgical 
chest worth £48, of surgeons to 2s. 6d. daily and of mates Is. daily, with the customary 
stoppage of 2d. monthly from each soldier's pay for medicines, and a surgical chest worth 
£17 to each surgeon attending 250 men. The Corporation was also authorized to raise 
surgical personnel by impressment, and to appoint 10 examiners to ascertain the fitness of 
candidates for admission to the Corporation. The Bishop of London or Dean of St. 
Paul's, with this board were empowered to examine all practitioners in surgery, up 
to the Statute of 18 George II in 1745. Before this time the Corporation of Surgeons 
acted as Directors General of both army and navy. In spite of all this, and of the very 
liberal allotments of surgical chests, there continued to be great suffering among the troops 
during the Parliamentary Wars from the rigors of climate and the effects of communicable 
disease. The devastating epidemic at the siege of Reading (1643), as described by the 
clinician Thomas Willis (himself a private soldier at that time), was either typhus or 
typhoid fever, or perhaps a combination of both. A Parliamentary resolution passed on 
March 6, 1643 empowered the raising of parochial funds for the relief of disabled soldiers 
and the widows and fatherless children of slain persona (Gore). During the reign of 
Charles I the army in Ireland had a physician general, the British East India Company 
had a surgeon general, and regimental surgeons and surgeons' mates were added to the 
medical personnel. The few physicians of any ability attached to armies came either from 
Oxford or the continental universities. Among these were the celebrated Richard Wise- 
man and William Harvey, both attached to the Royalist Armies, Dr. Edward Verney, 
the King's standard-bearer, who was killed at Edgehill; Dr. Wilson, the King's physician, 
who later shared his captivity at Hampton Court, Thomas Skinner, physician to Monk in 
his Scotch campaigns, and the anatomist Monro, attached to the Scots regiments. With 
the fall of the Commonwealth and the accession of Charles II (1660), the Parliamentary 
army was disbanded, and the Royalist forces were cut down to eventually four regiments 
and the Guards (1680), a force of about 5,000 men, with regimental, instead of company 
surgeons. During the occupation of Tangier by British forces (1664-84), the suffering 
and losses among the troops are described as immense and the services of the surgeons 
arduous. On October 27, 1679 a Royal Hospital for aged and disabled soldiers was 
established at Kilmainham, near Dublin. A private retreat for the same purpose had 
been established at Hereford by Sir Thomas Coningsby in 1G14. Chelsea was founded 
in 1663 and Greenwich (for seamen) in 1695. 

Upon the accession of James II (1685) new regiments were added to the Regular Army, 
necessitating an addition of 11 surgeons and 11 surgeons' mates, and a regulation was 



Seventeenth Century 127 

issued granting a pension of one year's pay from the "King's Bounty," for loss of an eye 
or limb, upon certificate of the chief medical oflBcer of the army, now called "surgeon 
general." At this time it was customary for medical officers to hold double commissions, 
receiving pay both as combatants (ensigns) and for hospital duties. The pay list of 
1686 gives a surgeon 6s. 6d. per diem and an ensign 3s. per diem. The medical officer 
wore the bright scarlet uniform of his regiment. After the Revolution of 1688 and the 
accession of William III, nine regiments, with medical officers were added to the army. 
The siege of Londonderry and other features of the Irish campaign again occasioned great 
suffering from disease. Some 24 French surgeons were added to the forces in Ireland in 
1690. Of this army Dr. Patrick Archibald was "Chirurgeon General" and Sir. Patrick 
Dun, Physician General (1688) at 10s. a day. The latter was succeeded in 1713 by Sir 
Thomas Molyneux. The depredations of the armies of Louis XIV in the Palatinate led 
to the Grand Alliance of 1689, in which English forces participated until the peace of 
Ryswick (1697), after which the British Army was cut down to 7,000 men, with a corre- 
sponding reduction in medical personnel. 

Russia^^ 

The development of the Scandinavian-Russian civilization was terribly impeded by 
the Mongol invasions and Russian medicine owes its origins to the Romanoff dynasty 
(1613-45), under whom a Ministry of Medical Affairs (Aptekarski Prikaz) was founded 
in 1620. Prior to this event, many English and other foreign physicians had been invited 
to settle in Russia by Ivan III and Ivan IV (1468-1584). This Ministry, the starting point 
of the patriarchal organization of medicine in Russia, had for its origins sundry drug- 
stores or medical supply stations for the dispensation of medicines. Its president was 
regarded as the highest official in the Empire, and its membership included the body- 
physician of the Czar. In 1615 a physician attached to the army is mentioned in the 
archives, and again, in 1631, when the forces were increased, both subordinated to the 
Medical Ministry. Prior to this time, sums of money were set aside to pay barber-surgeons 
for the care of the sick and wounded in campaign. In the second half of the 17th century 
regimental field dispensaries were instituted, with funds of 200 rubles per annum. These 
developments were materially forwarded by Peter the Great (1690-1725) under whom the 
Ministry of Medical Affairs became a Chancellery in 1707. A ukase of 1716 assigned to 
each division of the army a physician, a staff-barber and two apothecaries, a surgeon to 
each regiment, and a field-barber to each company; at the same time, field hospitals were 
instituted. 

Military Surgery in the \lth Century^'' 

Frederick the Great relates in his Memoirs that in the armies of the 
Great Elector one-third of a battalion were armed with pikes, two- 
thirds with muskets, and that not before 1700 were the entire infantry 
provided with firearms. Canister (caseshot) and bomb-shells were 
employed in the artillery, the latter usually as hand-grenades. The 
iron ramrod, introduced by the Prince of Anhalt-Dessau {circa 1098- 
1718) enabled the infantry to load and fire with greater rapidity. At 
first the round lead bullets seldom underwent deformation by reason 
of the slight propelling power of the charge, and in consequence, as 

" Knorr: op. cil.. .■?84-392. 

"For further data on the subject, sec Koehler: VeraffenLl. a. d. Geb. d. MU.-San.-Wesens, Berl., 
Heft. 13, 1899, 41-50. 

WolzendorfT: Deutsche med. Wochenschr., Leipz. & Berl., 1892, XVIII, 550-553. 



128 History of Military Medicine 

becoming rapidly encysted in the blind canals created, were frequently 
allowed to remain within the body until a favorable opportunity or an 
actual necessity for removal. But with greater propulsive power in 
the weapons there was eventually deformation of the projectile with 
laceration and mangling of the tissues, which was even more pronounced 
in the case of bullets of stone, iron, copper, glass or slag. Such wounds 
were almost invariably the seat of suppuration, all the more exaggerated 
through the practice of widening the wound by the surgeon's fingers or 
instruments to remove the bullet, and the then common practice of 
primary debridement. All the surgeons of the century were keen for 
prompt removal of the bullet, and Fare's teaching having obliterated 
the notion that gunshot wounds could be poisoned, surgeons were only 
too ready to explore open wounds with dirty fingers. The whole matter 
remained a ghastly chapter until cleared up by the teaching of Lister 
and La Garde. In the 17th century gunshot wounds were dressed 
with strange salves, compounded of nauseating ingredients, boiled 
with turpentine or camphor, happily disinfected by the heat in the 
first instance. If in spite of this there was septic fever, blood-letting 
was instituted at once. The almost universal stuffing of wounds with 
charpie was a frequent cause of infection and hospital gangrene. Such 
superstitions as the weapon salve, the sympathetic powder, and the 
"transplantation cure" (dipping a bit of wood in the blood or pus of 
the wound and pegging it into a tree) were at once phases of the curious 
doctrine of "action at a distance" and a vague groping toward the 
rational plan of leaving the wound to heal of itself. If the sliver of 
wound grew into the tree, the wound would heal over. These super- 
stitions, while ridiculed by Purmann, Fabricius, Wiirtz and the 
other surgeons, did not die out until the middle of the 18th century, 
and were even recommended to Frederick William I of Prussia (during 
an attack of gout) by two of his generals, in 1737. 

The 17th century was the great period of amputating limbs, which 
was done with reckless profusion by the half-instructed surgeons of the 
time, until the stand taken by Frederick the Great and the strong 
protest of Bilguer in 1768 put a stop to the fashion. Wholesale lopping 
off of limbs ofttimes resulted in the speedy death of the patient from 
shock and hemorrhage and filled the streets of the cities with mendi- 
cant cripples, whose grotesque yet wretched status has been forcibly 
commemorated in art by Bosch, Brueghel and Callot. The principal 
indications for amputation were cold, dry and moist gangrene, but un- 
fortunately the apprentices resorted to any excuse for practising on 
their patients to bolster up their own conceit. Fabry of Hilden, in 
his treatise on gangrene (1593), was the first to recommend amputation 



Seventeenth Century 129 

above the diseased part, and improvised a rude tourniquet to shut off 
the circulation, consisting of a ligature tightened by a stick of wood. 
The cautery was still used to check hemorrhage and pain was some- 
times annulled by the old mediaeval device of allowing the patient to 
breathe a sponge steeped in a mixture of opium, hyoscyamus and 
belladonna. It is said that Wiirtz taught the immediate closure of 
chest wounds before Larrey, but, as this doctrine was opposed by 
Fabry, such wounds were treated by widening, drainage, injections 
and paracentesis of pus. Gunshot wounds of the abdomen were some- 
times drained, but in spite of the current belief in "laudable pus," 
the general practice of drainage in wound-treatment was not standard- 
ized until the advent of John Bell. Gunshot wounds of the urethra 
were noticed by Purmann, Hutter and Scultelus. 

The leading English exponent of military surgery was Richard Wiseman (1622-76), 
who served with the Royalist forces and who summed up his extensive experiences in his 
treatise of 1672 containing many case histories. He employed primary amputation in 
gunshot wounds of the joints, first described scrofula (King's Evil) and tuberculosis of the 
joints (tumor albus), and in his treatise on gonorrhoea, mentions the first case of external 
urethrotomy for stricture, which he performed with Edward Molins in 1652. The first 
ease of flap amputation is recorded by James Yonge (1679). In Matthaeus Gottfried 
Purmann (1649-71),^' who served in the Brandenburg Army for nine years (1671-79), 
the Great Elector had, attached to his service, the best German surgeon of the time. 
He was a bold, resourceful operator, even invading the brain and the clavicle for bullets, 
and his fifty cases of gunshot wounds (1693) and eighty curious observations (1710) 
include bronchotomy, suturing of the intestines, trephining (40 cases), lithotomy, eye 
surgery and orthopedics. His experiences covered the battles of Fehrbellin and Rathenow 
and ail the sieges of Pomeranian towns. He complains bitterly of the difficult extraction 
of splinters from wounds made by glass hand grenades. Wilhelm Fabry of Hilden (1560- 
1624), the father of German surgery, wrote important treatises on gangrene (1593) and lith- 
otomy (1626) and left another admirable set of 100 case histories (1606-46). He reasoned 
that head injuries may cause insanity, extracted iron splinters from the eye with a magnet, 
devised an aural speculum and the first field chest of drugs, based upon the model pro- 
posed by Mority of Nassau (1612). Johann Schultes (1595-1645), called Scultetus, 
published in 1653 an atlas of surgical operations and instruments, which, with the later 
treatise of Heister (1718) is our principal source-book for the graphics of operative pro- 
cedure in the time. 

In France Nicolas de Blegny (1652-1722) invented the elastic truss (1676), and Morel 
introduced the tourniquet (1074) which was successfully applied in ligating the femoral 
artery at the Hotel Dieu in 1688, and Jacques de Beaulieu (1651-1719) or Frere Jacques, a 
strolling incisor, introduced the lateral operation for stone (1697). 

In Italy Cesare Magati (1579-1647) taught the treatment of gunshot wounds with 
bandages soaked in plain water, and Giuseppe Zambeccari was a remarkable pioneer in 
experimental surgery of the viscera, employing dogs for this purpose. Pietro de Marchetti 
(1589-1673) left one of the best repositories of medical and surgical cases (1664). The 
surgical knowledge of the earlier period is summed up in the gigantic Thesaurus of Peter 
Uffenbach (1610). 

'•For a full account of Purmann, includiiif; his auliihiofe-rapliy, sec Koliler: VerofTentl. a.d. Geb. d. 
Mil-San.-Wesens, Berlin. 1899. I.-J Ileft. 86-114. 



130 History of Military Medicine 

Epidemic Diseases 

Throughout the whole of the 17th century the European peoples were harassed by 
almost continuous wars or the natural sequels of lengthy wars, viz., devastating disease and 
starvation. During the Thirty Years War the opposing armies marched and counter- 
marched all over central Europe, and wherever they went, wherever they were camped or 
billetted, they were at once victims and carriers of bubonic plague, camp dysentery, 
syphilis, typhus and typhoid fevers, while, through their reckless destruction of material 
supplies and the impossibility of continuous sowing and harvesting, famine always went 
in their train. The story of these miseries, too lengthy to be repeated here, has been told 
in all its ghastly details by Gottfried Lammert (1890)" and Englished by Prinzing (1916).'" 
By the end of the Thirty Years War Germany was a ruined, desolate country, its popula- 
tion reduced from 16-17 millions to 4 millions (Lammert).'' According to the Excidium 
Germaniae, "one could wander ten miles without seeing a soul, scarce a cow." By the 
17th century leprosy had been almost completely stamped out, and the lazar-houses 
were abolished, but bubonic plague was rampant everywhere, with a mortality of 127,000 
in Moscow (1601-03), 80,000 in Milan (1630), 69,000 in the Great Plague of London (1665), 
70,000 at Vienna (1679), 83,000 at Prague (1680), and over 500,000 in the Venetian Repub- 
lic. Ne.xt to the plague typhus fever (Hungarian disease) was most fatal in its incidence. 
Hungary was called "the German's graveyard." Influenza and ergotism were common. 
Small pox was pandemic in 1614 and'epidemic in England in 1666-75, eventually reaching 
North America, where yellow fever was already endemic. Scarlatina, described by Doering 
(16:25-8) and Sennert (16^8), was first clearly differentiated from measles by Sydenham 
(1676). Infantile mortality was exceptionally high in this period. 

Account oj Pediculosis in Army Camps by Tobias Cober (1606)^'* 

In 1606 Tobias Cober, a physician of Gorlitz (Bohemia) who had 
seen seven years mihtary service in the "Long War" between the 
Hungarians and the Turks, pubhshed three series of "Medical Observa- 
tions in Hungarian Camps," in which he gives a lengthy account of the 
prodromes and symptoms of camp typhus, then known variously as 
morbus hungaricus, lues pannonica, languor pannonica, etc. In noting 
the effects of mental excitement and fatigue in predisposing to the dis- 
ease he refers particularly to the mental irritation produced by the 
swarms of mosquitoes, gnats and lice that infested the camps. The 
following extract is perhaps the first account of pediculosis in camp: 

With these foregather the most terrible pediculi, hardly to be thought of without a 
sense of discomfort, which in themselves, through their constant promenading and sucking 
of the body, are enough to stir up one's bile. For it is impossible to avoid the bites of these 
miserable creatures, especially in the first j'ears in the field, as they enjoy a sort of right 
of citizenship in all camps. The atmosphere is so lukewarm, mild and stuffy that when 



" G. Laramerl: Geschichte der Seuchen, Hungers und Kriegsnot zur Zeit des Dreissigjahrigen 
Krieges. Wiesbaden, 1890. 

2" ¥. Prinzing: Epidemics resulting from Wars, Oxford, 1916, 23-79. 

2' Prinzing (p. 77) regards this as exaggeraled, as other estimates claim that Germany lost one-half 
its population. Saxony lost 934,000 In 1631-2 alone. The population of Hohemia is said to have 
decreased from three millions to 780,000, and Wiirttemberg from 444,800 to 97,300. 

" T. Cober; Observationum mediceirum castronsium Ilungaricum decades tres. IIeImstS.dt, 
685, 49-51. 



Seventeenth Century 131 

clothes which have been washed in swamp water are exposed to the sunhght, they are 
seen to swarm with these " vermibus Syllanis." One cannot hope therefore to get away 
from these constant attendants and companions, as they seem to arise from the very 
moisture of the body itself. At first I thought to rid myself of the pest by constant 
change of newly washed clothing, but even this seemd to bring them more and more into 
play, instead of destroying them. And this phthiriasis, which even the Egyptian magi of 
old could not produce, but which in these localities every one can create in his own person, 
can, as I bear witness, drive a man into fury. For as often as I was bitten by these miser- 
able, abject animalcules, I gave full rein to my anger, fairly gnashing my teeth with rage, 
and cannot even now think of them without vexation. . . . One cannot ward off these 
armed six-footed Turks even with iron and steel. . . . And among many soldiers I have 
noted the frightful spectacle that this fearful plague of lice had gone far enough to cover the 
whole nape with ulcers, the flesh not only excoriated to the breadth of one or two fingers, 
but actually excavated, the men condemned to this miserable fate dying with groans and 
lamentations. 

A Camp Hospital Regulation of the \lth Century^^ 

The armies of the Landesknechte had occasionally a few tents (Krankenzelte) set up 
for the sick and wounded in camp, but the first definitely organized military hospitals in 
Germany were those authorized by Elector Maximilian of Bavaria in 16£0 for the armies 
of the Catholic League. One of these was an interim hospital or casualty clearing station 
in the field, the other a permanent main hospital in the nearest town. None of these 
earlier camp hospitals were mobile field hospitals of recent type; the term "field-hospital" 
is applied to them by courtesy. In June, 1685, following the bloody battle of Fran between 
the Imperial forces and the Turks, the Brunswick troops acquired field or camp hospitals, 
and a set of regulations for these was drawn up by Konrad Barthold Behrens (1660- 
1736) and published in 1689.^^ These hospitals were massive, many-storied buildings, 
run up in the vicinity of the camp, on good sites in the neighborhood of wood and water. 
Dysenteric or other patients were segregated in well ventilated rooms, according to 
diseases; yet while strict cleanliness is enjoined in the regulations, hospitals were not popu- 
lar with the sick, and the caution against the passage of faeces and urine through cracks and 
knotholes into rooms below, points to jerry-building and the squalor of the time. The 
personnel consisted of the physicians, whom the patients were allowed to choose, the field- 
barbers, apothecaries and attendants, usually priests, captains and female camp followers, 
the whole supervised by an officer with soldiers. The duties of the physicians were to 
detect malingering and to prescribe diet and medicines for the sick, but with 800 sick 
soldiers daily in 1685, only a word could be devoted to each patient, and the order had to 
be carried out by the barbers, the medicines being subsequently prepared by the apothe- 
caries in the presence of the physicians. The apothecaries were required to keep a full 
supply of medicines on hand, making timely requisitions where necessary, and relying 
mainly upon vegetable simples, for economic reason. Candles, salt, sugar, olive oil, nut- 
megs, oatmeal, rice, red wine, brandy, juniper berries and vinegar were regarded as the main 
staples. The patients lay upon linen sacks filled with straw and a plentiful supply of 
linen for bandages is specified. To each hospital was attached a commisarius or finance 
officer, who provided funds and regulated the accounts. A picture of the interior of a 
military hospital of the period forms the frontispiece of Andreas Hiitter's Fifty Surgical 



23 W. Haberling: Arch. f. Geach. d. Naturwissensch. u. Technik, 1918, VI, 150-159. 

" K. B. Behrens: Consilium oder rilhliches Gutachten wie ein Soldat im Felde fiir Eranckheiteo 
sich hiiten und denselben zur Nolh begegnen konne. Hildesheim, 1689. For the text of the regulations. 
Bee Haberling: op. cit., 156-169. 



132 History of Military Medicine 

Observations (1718).^^ It represents a large commodious ward, opening by an arched 
doorway upon the distant camp, through which the wounded are brought in on litters, 
while the surgeon and his apprentice, in justaucorps coats hover about the beds. The 
furniture (beds, table, chairs) is of the heavy, ornate, household type, and was probably 
obtained from neighboring residences. 

Attempts at Regulation of Prostitution in Armies"^^ 

Never were mobilized armies so beset and hampered by hordes of 
camp followers as during the Thirty Years War. Schiller states that at 
the siege of Nuremberg (1632), there were 15,000 loose women in Wallen- 
stein's camp alone and Wallhausen (Defensio patriae) counted 4,000 
women and their offspring attached to a single regiment of 3,000 Ger- 
many infantry, the 300 wagons of the train being loaded down with 
these camp-followers and their plunder. In 1648 at the end of the war. 
General Gronsfeld reported to Elector Max of Bavaria that the Imperial 
and Bavarian armies consisted of 40,000 soldiers, who drew rations, 
and 140,000 prostitutes and camp-followers, who drew none. In 1650 
the four Swedish companies that revolted at Kothen numbered 690 
soldiers, 650 women and 900 illegitimate children. This condition, 
an essential feature of the then current concept of the regiment as the 
"home of the soldier," persisted diminuendo until the end of the 18th 
century. In the earlier period these kept women, plying their various 
avocations as laundress, sempstress, cook, sick-nurse, midwife, bar-maid 
and concubine, had the strongest hold upon the soldier, and the various 
devices resorted to by commanders to get rid of them were speedily 
outwitted by the troops themselves, in spite of innumerable orders and 
regulations everywhere. The first plan hit upon, explicitly stated in 
the Articles of War of Maximilian II (1570) and repeated in the cavalry 
regulations (Reiterrecht) of Wallenstein (1617) and those of Gustavus 
Adolphus (1621) and the Great Elector (1656), was to forbid any 
women in camp, unless duly wedded soldiers' wives. But this only 
resulted in countless "drum-head marriages," often with women of the 
lowest character (Wallhausen records as many as 800 marriages in 
two days). Attempts to leave the horde (Weibertross) stranded in 
crossing a stream were always circumvented by the humorous protests 
of the soldiery, who declined to march farther. Regulations, such as 
those of Ferdinand III of Hungary (1643-1645), authorized the driving 
away of women with whips and by heavy fines for the soldiers, but are 
said to have only increased the number in the long run, due to the 
general starvation of the people, and the fact that an adventurous 



25 For reproduction of which see Wolzendorff: Deutsche med. Woehenschr., 1892, XVIII. .S.t3 
" W Ilaberling: Das Dirnenwesen, etc. Ztschr. f. Bekampf. d. Geschlechtskr., Leipz., 1914, XV, 
312-326. 



Seventeenth Century 133 

camp career permitted a livelihood by theft and plunder. Military 
orders, too numerous to mention here, went the length of severity, but 
such barbarous devices as cutting off ears and noses or that of passer par 
les verges, were unavailing, until troops were quartered in closed bar- 
racks. The wretched offspring of soldiers' mock marriages were 
doomed to fill the brothels and thieves' kitchens. Almost nothing is 
said of syphilitic infection in the military regulations of the time, al- 
though Fronsperger, in his Navy Regulations, had mentioned it as a 
reason for not permitting women on board ship. In his "Discourse on 
the present German Army" Count John of Nassau-Siegen, one of the 
leaders in the Protestant Union (1608)," filed a vigorous protest against 
the Weibertross, proposing that they be excluded rigorously from camp, 
"to prolong the soldiers' lives and to protect the camp from contagious 
diseases." This is again repeated in the Spanish Articles of War of 
1681 and in the ninth article of an edict of the Magistrate of Strassburg 
(1684), in aid of protecting the troops quartered there "from infection." 
It was not before the middle of the 18th century (1750) that orders began 
to appear authorizing medical treatment of diseased camp-followers 
prior to imprisonment. Success in suppressing vice and disease in 
armies varies inversely with the number of troops mobilized. In the 
17th century it was not possible, even with the smallest detachments. 

The Exhortations of Gehema 
Across the four centuries comes a voice raised to denounce the 
indifferent care of the sick and wounded soldier by the half-baked 
medical personnel of the period, a voice crying in the wilderness. It is 
that of Janus Abraham a Gehema (1647-1715), ^^ a Polish knight and 
master of horse, who, orphaned in childhood, trailed a pike in the Low 
Countries, studied medicine at Groningen, Leyden and Utrecht, and 
like most rolling stones of the time,^^ served in nearly all the wars of 
the period in various capacities, to settle down finally in Berlin as court 
physician and upper-herald to Frederick- 1 of Prussia. In his roving 
life he seems to have married five (some say seven) wives in succession 
and to have turned out, along with a large family of children, some 
thirty books bearing such queer titles as "Gout Conquered by a Chinese 
Weapon, the Moxa" (1683), "The Best Way to Kill Time" (1686), 
"The Noble Drink, Tea" (1686), "The Conscientious Wet-Nurse" 
(1698), "Two and Twenty Fever Cures" (170:2), etc. His fame rests 

" W. Haberliag: <)/>. cil., 173-174. The text is said to be in the Dillenburger Archiv at Wiesbaden, 
K. 938. 

"For the life of Gehema see Kohler: Veroffentl. a.d.Geb. d. Mil.-San.-Wesens, Berl., 13. Heft, 
1899, 52-85. 

'» Another roving character of this order is described by A. KObler in Berl. kJin. VVochenschr., 
1918, LV, 1083. 



134 History of Military Medicine 

securely upon three books which are now highly prized and esteemed, 
namely, "The Well-Experienced Field-Physician" (1684),3o "The 
Officer's Well-Arranged Medicine Chest" (1688),^' and "The Sick- 
Soldier" (1690) .^2 In these Gehema appears as a notable exhorter 
and hot gospeller for the soldier's welfare, garrulous at times like Pare 
or Paracelsus, but with the same native fire in his soul that is apparent 
in the great medical reformers of the Renaissance. 

The burthen and plaint of his argument is that through the divorce between 
medicine and surgery, hundreds of soldiers had to die because they were attended in 
illness, not by the field-physician, but by ignorant barbers, and then usually not even 
by the regimental barber, but only his apprentices, who were as little fitted for the surgical 
calling as "a jackass at a dance"; furthermore it was hopeless to attempt to keep a field 
army of 20,000-30,000 men in good condition with but one physician at best to look after 
them and with field-chests filled with idiotic remedies. These chests, Gehema main- 
tained, should be furnished not out of the physician's pocket but by his government. 
The pictures given by historians of the low status of medicine in the 17th century are 
usually taken from Gehema, whose books afford the most vivid sidelights on the military 
medicine of the times. "Can there be," he cries, "any more miserable creature under 
the sun than an unfortunate soldier.' O ye oflacers! think that such an one is not made of 
wood or stone, but is a man and exposed to the same chances as yourselves. . . . Few 
indeed have I seen who took enough pity on the sick soldier to visit his bedside, give him 
some attention and send him food, which would cost very little." 

To Gehema's protestations, however, the 17th century authorities were 
as indifferent as the pest-doctor of the time, who saw his patients behind 
a pane of glass, while his apprentices attended them. Speaking of the 
lengthy literary productions of the period, James Russell Lowell ob- 
served, with the exaggeration of American humor, "We wonder at 
the length of face and general atrabilious look of the men of that genera- 
tion, but it is no marvel when even their relaxations were such down- 
right hard work," The gloomy sepulchral spirit of the 17th century is 
expressed in the lines of one of its poets : 

"Devouring Famine, Plague and War, 

Each able to undo mankind. 

Death's servile emissaries are" 

and this mortuary feeling, if nowise apparent in Spinoza or Moliere or 
Rubens, is to some extent perceptible in Milton, in Bach, in Bunyan 
and Sir Thomas Browne. It was not without reason that Mazarin 
inquired concerning any commander recommended to him, if he pos- 
sessed the cheerful, fortunate disposition necessary to the successful 
conduct of military operations — Est-il heureux? 



•" Wohlversehener Feld-Medicus, Hamburg, 1684. 
" Wohleingerichtete Feld-Apotheke. Bremen, 1688. 
32 Der kranke Soldat. Stettin, 1690. 



CHAPTER VII 
The Eighteenth Century 

The 17th Century, a period of almost continuous wars, of intense 
individuahsm in science set off by a distinct backward trend in practical 
medicine, was now to be succeeded by a phase of relative quiescence, 
interrupted at intervals by wars of brief duration, but tending, in the 
end, to a social order in which everything was to be regulated by sober- 
sided method and system. It was the illusory resting stage of apparent 
contentment with "the best of possible worlds,"^ which preceded the 
stormy years of the French Revolution and the Napoleonic Wars. 
Carlyle characterized the 18th century as "spendthrift, fraudulent, 
somnambulistic, bankrupt," tending naturally to its suicidal end; and 
there is much in his formula for the general law of its being: "Souls 
extinct, stomachs well alive. "^ In this artificial, somewhat shallow 
and highly materialistic age, the powerful and prosperous enjoyed a 
degree of elegant leisure almost inconceivable today and only compa- 
rable with that of the later Roman period; but underneath the veneer 
and varnish the miserable status of the less fortunate can be definitely 
sensed from the Hogarth drawings, the novels, memoirs and police 
records of the time. The solemn, lengthy, cadaverous faces of the 17th 
century give way to the ruddy, heavy-jowled, eupeptic personalities 
of the three-bottle men.' Each person had a definite place in the 
scheme of things, and in it he was expected to remain. Medical prac- 
tice was passed on from father to son. Doctor, lawyer, divine, soldier, 
courtier, tradesman, had each certain peculiarities of costume, manner 



' Leibnitz emitted the famous dictum " Tout est pour le mieux dans le meilleur des mondes possibles," 
ridicule of which was the motive of Voltaire's "Candide." 

'It is to be uoted that this is the viewpoint, not of the professional moralist or clergyman, but of 
the sardonic humorist that Carlyle happened to be. To the conventional-minded the 18th century 
is the ideal and idyllic period of sober quietism and virtue rewarded, as sensed in the Mozart or Haydn 
symphonies, the Handel oratorios, the Reynolds and Gainsborough canvases, the literary productions 
of Addison, Goldsmith. La Fontaine, etc. The history of the hospitals, psychiatry, infant mortality, 
and poor-laws, tells a ditferent story. The poetry is artificial; the music "tailor-made." Bach lived 
in the 18th century, but his music is of the 17th century in its deep religious feeling and its ineffable sad- 
ness — a requiem for those lost in the Thirty Years War. Stendhal (Napoleon's quartermaster) lived 
in the 19th century, but is a typical 18th century figure. 

'Gibbon was so corpulent that when he proposed to Mademoiselle Curchod, he was unable to rise 
from his kneeling posture. Chodowiecki's etching, "A physician's proposal of marriage," summarizes 
this phase. The Romeo is stout; the soubrette stouter. 

135 



136 History of Military Medicine 

and intonation that identified them, hke players in a stock company,* 
and even knaves and blackguards acted up to their respective parts 
with aplomb and precision. Extreme servility in dedicating books and 
in other approaches to noble patrons was regarded as correct procedure. 
The advent of such dynamic, independent personalities as Frederick 
the Great, Dr. Johnson, Edmund Burke, John Hunter, Napoleon or 
Beethoven was as a series of shocks of high voltage to a society that 
permitted Mozart to starve and to be kicked downstairs by an arch- 
bishop's lackey. Oliver Goldsmith noted with precision the birth of a 
more modern trait, that of snobbery. As among the Romans of the 
Empire, the sexual and sentimental life of the time was a purely physical 
phenomenon, and, though sincere private affection may be sensed in 
the lives of the "happy few," the general pursuit of carnal recreation 
was methodistic, systematic and hard as nails.* 

In medicine the mania for formal theories and systems of method 
ran an extraordinary pace, although this century was, financially and 
socially, the "Golden Age" of both practising physician and quack. 
Haller, Boerhaave, Stahl, Hoffmann, Cullen, Barthez, Borden, John 
Brown, had each an artificial "system" or way of looking at disease, 
all his own, and by which he diagnosed and prescribed for his patients' 
troubles. Private or secret remedies were the vogue; any formula that 
"worked" in practice was jealously guarded, as part of the pedestal 
upon which the physician stood with reference to his particular "theory" 
of disease. Yet there were clinical advances of extraordinary signifi- 
cance, which can only be appreciated in relation to their modern appli- 
cations. 

Floyer published his "Pulse Watch" in 1707. Marline and Currie introduced clinical 
thermometry (1740-98). Auenbrugger discovered the art of percussion (1761). The 
Hahn family introduced the use of the cold pack in fevers and Currie himself gave cold 
baths in typhoid. Withering introduced digitalis. Galvani, Volta and Franklin furnished 
the means for electrotherapy. Heberden, Fothergill, Lettsom, Parry, Huxham, Baker 
and Pringle added to the luster of English medicine by their close notations of new diseases 
at the bedside. More diseases were accurately described in this period than ever before. 



• Of this amusing phase there are endless examples in the waspish antitheses of Pope, e.g., 
'"Boastful and rough, your first son is a Squire; 
The next a Tradesman, meek and much a liar; 
Tom struts a Soldier, open, bold and brave; 
Will sneaks a Scriv'ner, an exceeding knave; 
Is he a Churchman.' then he's fond of power; 
A Quaker.' sly; a Presbyterian? sour; 
A Smart Free-thinker.' All things in an hour." 
' Litmus tests of this proposition are: the fiction of the entire period, from Clarissa Ilarlowe to 
Faublas; the drama prior to Goldsmith and Sheridan; the moralities in Rousseau; Hogarth, the one 
realistic artist of the time; the early youth of Frederick the Great and his final phase; the epitaph of 
Francis Charteris; the Pare aux Cerfs and its relation to the French Revolution. It is highly significant 
that Frederick the Great (certainly no moralist) could have had Russia as his ally in the Seven Years 
War, had he not dubbed the Czarina "Vinfame calin da nord." 



Eighteenth Century 137 

Gross pathology became a science at the hands of Morgagni (1761) and Matthew Baillie 
(1793). Jenner introduced preventive vaccination (1796-98) and first described anaphy- 
laxis (1798). In forwarding the technic of operative surgery France took the lead, even 
beyond the time of John Hunter, the founder of experimental surgery. The manage- 
ment of obstetric cases was vastly improved by William Hunter, Smellie, Charles White 
and others. Brisseau, Mattre-Jan and Daviel developed our present knowledge of 
cataract and its treatment. Anatomical illustration in copper and steel attained the 
heyday of its perfection. The true physiology of respiration (hinging upon the discovery 
of o.xygen) was developed by Black, Priestley, Lavoisier, La Place and Lagrange (none of 
them medical men); and the science of blood-pressure owes its origins to Stephen Hales 
(an English clergyman). Ramazzini WTote the first book on industrial diseases (1700) 
and Frank the first scientific treatise on public hygiene (1777-78). 

In the 18th century the administration of military medicine became 
a definite function of government, and, in consequence, limited periods 
of voluntary enlistment, regular medical examination of recruits, 
regular salaries for officers, government quarters for troops, regular 
uniforms, a common daily ration, the military regulation of army 
hospitals, printed orders and bulletins on military paper, periodicals 
devoted to military medicine, and regular schools of military medicine 
(in Prussia and Austria) became part of the established order of things.^ 
Thus military medicine profited by the 18th century cult of formal 
systems and elaborated routine. 

Infantry was now armed with fire-arms exclusively, and through the hard cogitations 
devoted to the art of war by Prince Leopold of Anhalt-Dessau and the Marechale de Saxe, 
it acquired great efficiency. Martinet, whose name is synonymous with formal meticulous 
precision, introduced regularly planned camps (1667), the use of the bayonet (1669), the 
organization of infantry cadres by companies and battalions, pontoon bridges, newer 
tactical evolutions, etc. Of the elder Dessauer Carlyle observes:' "He invented the 
iron ramrod; he invented the equal step; in fact, he is the inventor of modern military 
tactics. . . . The soldiery of every civilized country still receives from this man, on 
parade-fields and battle-fields, its word of command; out of his rough head proceeded 
the essential of all that innumerable drill-sergeants, in various languages, daily repeat 
and enforce." 

Of the efiFect of Frederick's methods of volley-firing at close range upon relief of the 
wounded, Straub says:* 



• Limited periods of ealistment, first recommended by the Marfechale de Saxe in 1732, were definitely 
adopted by Venice in 1766 and by England in 1775. Medical examinations of recruits for militia were 
customary in France from 1726 to 1775; in England an inspector-general of recruiting for foreign 
service was appointed in 1778, but there were no regular medical examinations until 1790, and no written 
attests until 1799. Examinations were first authorized in Germany in the Prussian regulations of 1788. 
Salaries of medical officers, even of the Prussian surgeons general, were fluctuating, precarious and 
sometimes non-existent for a long period. Billeting on civilians was prohibited in England in 1745, 
but persisted elsewhere until late in the century, and was not abolished in Scotland until 1857. Build- 
ing of barracks began with Vauban in 17th century France, and was started in F^ngland in 1739. 
Uniforms were introduced in France by Louvois (1670-79). The first governmental hospital regula 
tions were French (1718). For specimens of printed government orders see the facsimile reproductions 
in Cabanes {Chirurgiens el blesses. Paris, 1918, passim). 

' Carlyle: Frederick the Great, Book IV, ch. 2. 

'Straub: Medical Service in Campaign, Philadelphia, 1910, 87. 



138 History of Military Medicine 

"During the time of Frederick the Great troops advanced into battle, shoulder to 
shoulder, to within 200 yards of the enemy, and sought to overcome him by superiority 
of fire; the contestant that could fire most rapidly had the best chance of being suc- 
cessful. Open ground was chosen by preference and the rescue of the wounded during 
the progress of the engagement was out of the question." 

Throughout the 18th century France, in consequence of Louis XIV's 
campaigns, became the "great nation," and was everywhere regarded 
as the centric authority in literature, painting, architecture, science, 
medicine, surgery, etiquette and the art of war. 

Military Medicine in France^ 

The first important advance made in French military medicine dates from an order 
of Louis XIV (January 17, 1708), which specifies that, in future, sick and wounded officers 
and soldiers shall be attended on the march and in hospital by a personnel of 200 physi- 
cians and surgeons, previously tried out by appropriate examinations, and consisting of 
4 medical inspectors general, 50 advisory physicians major {mcdecins-majoT) for hospitals, 
4 advisory surgical inspectors general, 4 surgeons major of camps and armies and 138 
surgeons major. At the same time military hospitals were erected in 51 French cities. 
Commissions for grades were sold to applicants, but the harmful arrangement was nul- 
lified in a royal order of Louis XV (1716). The first hospital regulations, a document of 62 
paragraphs, was issued on December 20, 1718, and became the basis of all similar regula- 
tions in France. It contains clear and exact directions as to the duties of hospital per- 
sonnel, medical treatment of patients, hygiene of attendants, administrative control of 
subaltern functionaries, and prevention of contagious diseases. Yearly courses in anatomy 
are prescribed for surgeons, and a garden of medici nal herbs is to be attached to each hospital 
from the date of construction. The making of wills by dying patients in favor of an 
institution, an order or an interested person is forbidden. An order of 1719 fixes the 
monthly pay of medical personnel as follows: physician in chief, 500 livres, 10 rations of 
bread; consulting surgeon, 150 livres, 10 rations; chief surgeon, 390 li\Tes, 6 rations; 
principal assistant surgeon, 150 livres, 4 rations; sub-assistant surgeon, 60 livres, 3 rations; 
boy (assistant), 50 livres, 2 rations; chief apothecary, 120 livres, 4 rations; apothecary's 
boy, 50 livres, 2 rations. In the field chief physicians and surgical consultants got 1,500 
livres for their equipment, and a bonus of 2,000 livres at the end of the campaign. These 
regulations were re-edited, in compressed form, in 1728, and on January 1, 1747, appeared 
a new royal order, combining the main features of both, and destined to be rescinded 
and reaffirmed at intervals throughout the century. The principal defect of this new 
order was the creation of a Commissariat de guerre (intendance) to usurp the legitimate 
functions of medical personnel. ^Tiile this was ostensibly designed to circumvent pecula- 
tion by contractors (punishable first by 1,500 livres fine, second by 9 years hard labor 
in the galleys), it had deplorable consequences for the actual relief of the sick and wounded, 
even to the end of the Seven Years War, by reason of the fact that the hospitals and 
ambulances of the first line were financed from the king's privy purse, those of the 
second line by the entrepreneurs or contractors. At the end of the Thirty Years War 
there appeared a serial designed to advance the interests of military hospitals, edited by 
Richard de Haut-Sierk, Inspector General of Hospitals, and entitled Recueil d' observations 
de medecine des hopitaux militaires (1766-72). This was followed by the first periodical 



•G. Marache; Diet, encycl. d. sc. m;d. (Dechanabre), Pdris, 1877, 2. a., VIII, 79-97, Caban^: 
Chirurgiens et blesses k travers I'histoire, Paris, 1918. 



Eighteenth Century 139 

to be devoted to military medicine, viz., the Journal de medecine militaire (Paris, 1782-88), 
which was revived at intervals as a Recueil in 1814, 1817 and 1871. During the period 
1747-9£ there was uninterrupted warfare between the physicians, surgeons and com- 
missariat of war, which manifested itself by many changes in orders. Thus an order of 
August 4, 1772 prescribes a Commission with exclusive control of the medical personnel, 
consisting of an inspector general, 5 medical inspectors and 2 surgical ditto. It was 
rescinded by an order of August 17, 1774 and the old arrangement of January 1, 1747 
was resumed. A royal order of 1775 authorizes the opening of lecture rooms for instruc- 
tion in military medicine in the hospitals of Metz, Lille and Strassburg. This, the first 
attempt at an army medical school, had later developments at Brest and Toulon. In 
spite of this advance the status of medical officers was still feudal. Louvois, the great 
minister of Louis XIV, and creator of the royal "standing army," endeavored to overthrow 
the proprietary system of mercenary forces (each regiment for hire and the exclusive 
property of its colonel) by giving wealthy young nobles the empty title of "colonel," or 
"captain," while the real work was done by lieutenant colonels or lieutenants. By this 
arrangement commissions and regiments could no longer be bought, but the result was a 
commissioned force of juvenile officers of high grade which blocked promotions for a life" 
time, while chief physicians or surgeons were still arbitrarily selected as vassals by these 
swaggering young courtiers. The educational order of 1775 was again abolished on Janu- 
ary 1, 1780 as incurring unnecessary expense to the state. In 1788 regimental hospitals 
were substituted for the general military hospitals in vogue, with a host of new instruc- 
tions and regulations. An order of May 18, 1788 embarked upon the dubious course of 
assigning control of military hospitals to a directorate made up of military and medico- 
military members, with a sanitary council {Conseil de sante) as adjunct. But before this 
(with three subsequent modifications) could be tried out by test, the whole edifice was 
swept away by the French Revolution (1789). The first act of the Constitutional Assembly 
was to abolish, in 1790, an edict of 1781 by which commissioned rank had been reserved 
for the aristocracy alone. This put new blood into the artillery and engineer schools, 
and from this class came Napoleon and some of his best generals. The Republic declared 
war on Austria on April 20, 1792. The armies created for this purpose by the revolu- 
tionary general Carnot, first by enthusiasm, later by remorseless conscription, were destined 
to raise the military reputation of France to the highest point and, under Napoleon, to 
obliterate the older 18th century plan of making war by set principles and mechanical 
rules. At first whole columns of the Republican troops melted away under the steady 
fire of disciplined regulars, but the gaps in the ranks were speedily filled up, and no head- 
way could be made against a "nation in arms" animated by ferocious patriotism. In 
contrast with previous wars there were few desertions, since each private was also a 
patriot and had a fanatical personal interest in the cause. At the outbreak of the war 
1,400 physicians and surgeons applied for entrance to the army, and many of these were 
lost by wounds or disease. By the law of August 1, 1793 the National Convention 
placed all physicians, surgeons and apothecaries at the disposal of the Minister of War. 
In January, 1793 2,570 medical officers had been raised; by the end of the year there 
were 4,000; in 1794 a maximum of 8,000 was attained. Meanwhile, in 1792, the 18 medical 
faculties and 15 medical schools of France had been abolished by vote, along with the 
Academic dc chirurgic ami the Societe royale ie medecine. In 1794 Ecoles de sante or 
schools of military medicine, with the graduating degree of oficier de sante, were created, 
in order to supply medical officers for the armies of the Republic. The efi'ect of this 
device of mob rule (always fatal to medicine) was chaotic. Medical education could 
have no firm grounding nor any definite course under such an arrangement. Training 
was superficial, practice was thrown open to anyone who could pay for a license. An 



140 History of Military Medicine 

actual specimen examination of a candidate of 1803, exhumed by Wickersheimer,'" dis- 
plays appalling ignorance. The evil was eventually checked by the firm hand of the 
First Consul, who restored the medical faculties to their proper status in 1804. 

The principal wars of this century were the wars of the Spanish 
(1701-13), Austrian (1740-48) and Bavarian Successions (1778-79), 
the Seven Years War (1756-63) and the three revolutions in Russia 
(1773), America (1775-80) and France (1789-94). 

War of the Spanish Succession 

In 1700 Charles II of Spain died and his successor was Philip of 
Anjou, grandson of Louis XIV. The view of the Grand Monarque 
that France and Spain were now one (// ny a plus de Pyrenees) brought 
about an alliance of England and Holland against him under such 
overtopping leaders as Marlborough, the greatest English commander 
before Wellington, and the redoubtable Prince Eugene of Savoy. But 
after thirteen years fighting, with the memorable battles of Blenheim 
(1704), Ramilhes (1706), Oudenarde (1708) and Malplaquet (1709) as 
victories for the Allies, the whole aspect of the question was changed 
by the succession of Archduke Charles of Austria to the throne of the 
Central Empire. This brought about a more dangerous possibility for 
Spain and thus left the Bourbon prince on the throne with a dissolution 
of the Alliance, set off by the acquisition of Gibraltar, Newfoundland, 
Nova Scotia and the Hudson Bay territory by England and of Milan, 
Naples, Sardinia and the Spanish Netherlands by Austria. The 
English forces numbered 40,000 out of a population of 10,000,000, 
and the French 200,000 out of 20,000,000. These forces were recruited 
by voluntary enlistment in France and partly by impressment in Eng- 
land, but poverty was the great recruiter of armies at this time. Louis 
XIV observed that "hunger would compel his subjects to follow the 
bread-wagons." Troops on both sides suffered great hardships from 
the barren condition of the countryside. The English forces were 
therefore followed by trains of bread-wagons and cattle. In his thought- 
ful consideration for the health and well-being of his men, Marlborough 
was equalled only by Frederick the Great. 

The introduction of a rhythmic, cadenced or metronomic step in marching exerted a 
profound effect on discipline and esprit de corps and enabled infantry to get over great 
distances without undue fatigue. Marlborough's celebrated march to the battlefield of 
Blenheim, covering 1,176 miles in 86 days, was accomplished by continuous movement 
during the cool morning hours (3-9 A. M.) toward a definite halting place, prepared and 



" E. Wickersheimer: Paris med., 1912-13, suppl., 749-851. Translation in Jour. Am. Med. Assoc, 
Chicago, 1913, LXI, 2001. This affords an amusing, yet dreadful example of the flippancy and irre- 
eponsibility of popular rulings in regard to a subject so grave and dithcult as medicine. 



Eighteenth Century 141 

rationed in advance by commissaries, and where the rest of the day was spent in rest. 
The result was that his troops looked, in the phrase of the Elector of Prussia, "as if dressed 
for a ball." Marlborough did everything he could to discourage intemperance and 
debauchery in camp, tried to impress his men with a sense of morale and self-direction, 
held divine service morning and evening, read prayers before and after battle, by which 
and similar means, his camp "resembled a well governed city." Before the action at 
Blenheim he took pains to have the surgeons shown the exact places for assemblage and 
care of the wounded. After the victory, he wrote to Godolphin: "I have been so employed 
about our own wounded men and prisoners that I have not had one hour's quiet." At 
the beginning of the campaign it had been promulgated in the British Articles of War 
that one day's pay be deducted annually for the hospital, and that all plunder taken before 
the end of a battle be forfeited for the use of the sick and wounded, and that one-tenth of 
the total spoils be set apart for the same purpose. The losses in the four great battles of 
this war were heavy, viz., 

1704— Blenheim: Allies, 5,000 killed, 8,000 wounded; British, 670 killed, 1,500 

wounded; French and Bavarians, 12,000 killed, 14,000 wounded, 14,000 

missing. 
1708— Ramillies: Allies, 1,066 killed, 2,867 wounded; French, 2,000 killed, 5,000 

wounded., 6,000 missing. 
1703 — Oudenarde: Allies, 3,000 killed and wounded; French, 6,000 killed and wounded, 

9,000 prisoners. 
1709— Malplaquet: Allies, 20,000-30,000 killed, wounded and missing (Infantry, 

5,554 killed; 12,706 wounded and missing); French, 6,000-16,000 killed, 

wounded and missing. 

In all these actions Marlborough shone as a great commander through his zeal for relief 
of the wounded. At Malplaquet evacuation of the wounded and burial of the dead 
occupied two days. At Oudenarde he broke the stereotyped rules of the "art of war" 
by forcing his tired troops, with their backs to a river, to destroy the enemy's right and 
centre under his very eyes. After nightfall the field was covered with wounded, mixed 
with the dead and dying, and here again, Marlborough's ingenuity was taxed to the 
uttermost. Malplaquet he described as "a very murdering battle," for here thousands 
of his old comrades were destroyed. In these battles it was som^imes necessary to 
break up the commissary wagons to make litters for the wounded. 

Development of Military Medicine in Prussia^^ 

Until the time of Frederick the Great the medical service of the 
Brandenburg a'-viies remained on the 17th century level, with little 
evidence of the governmental supervision which had become a fixed 
principle in France after January 1, 1747. 

Under Friedrich I, the first king of Prussia (1688-1713), company barbers were first 
subordinated to the regimental barber (order of November 4, 1712). Examinations to 
test the fitness of the latter had not been instituted before 1685. An order of November 4, 
1712 authorizes the regimental barbers to choose and pay field barbers and to procure 
medicines. The first order for the location of appropriate sites for military hospitals 
was promulgated on March 10, 1704. The first regular military hospital in Prussia was 
a house near the Spandau gate (Heriiu'l, set apart for the plague in 1710, and which was 
incorporated as the Charite by a royal order of September 5, 1725. 

Under Friedrich Wilhelm 1 (1710-40) an order of May 18, 1713 specifies that regi- 



" E. Knorr: op. cit., T:J-92. A. K.>eliler; Vero.Tcnll. a. d. Geb <i. Mil. San., Wesens. lierl., 1899, 
Heff 13. 23-41; 12':»-262. 



142 History of Military Medicine 

mental barbers shall have the rank and pay of subaltern regimental ofScers (a considerable 
advance in their then status), and shortly after his accession the monarch nominated the 
regimental surgeon of his guard, J. C. G. Brandhorst (1694-1740), to be general surgeon 
(Generalchirurgus) of the guard at a salary of 15 reichsthaler monthly. During 1716-19 
Brandhorst, Bouness and Cassebohm were sent to Paris to study. The first Surgeon 
General of the Prussian Army was Ernst Conrad Holtzendorff (1688-1751), who received 
this honor in 1716. His success in treating the king during a grave illness in 1719 won 
the royal confidence, and through this circumstance the Theatrum Anatomicum (founded 
1713) was expanded to include the Collegium medico-chirurgicum, for the higher instruc- 
tion of medical officers, on January 3, l7-2i; and medical officers were sent to France and 
elsewhere to complete their medical studies, at government expense. In 1734 the king 
was gravely ill with gout and dropsy. In gratitude for the skillful handling of his case 
by Eller and other physicians he presented 100,000 thaler to the Charite. 

In tlie reign of Friedrich Wilhelm I the Prussian army had increased from 30,000 
to 76,000-89,000 men. The intense personal interest of this king in the medical corps 
is indicated by his instructions to the Surgeon General of January 30, 1725: 

1. In the future no regimental barber will be accepted or dismissed without prior 
knowledge of the king. 

2. The applicant must appear before the Surgeon General; he must pass an examina- 
tion before the Collegium medicum on his knowledge of internal diseases and absolve a 
course in operative surgery. 

3. He must subscribe to his oath at the hands of the regimental auditor in the 
presence of the commanding officer. 

4. In the cavalry his pay will be 106 thaler monthly, of which he must disburse 6 
thaler to the barber of each squadron (10 in all) and pay for outfitting the field-chest 
and instruments. In the infantry he receives 1:2 thaler monthly from the staff and 
10 thaler monthly from each company, out of which (latter) amount, he must maintain 
the company barber at 5 thaler monthly and disburse the remaining 5 thaler for medicines. 
The field-barbers are subordinated to him and can treat no patients without his knowledge 
and consent. In detached companies their status is independent. Their duty is to 
shave the soldiers and to visit the sick. 

5. The regimental barber will report to the commanding officer daily at 11 a. m. 
and at other hours in urgent cases. 

6. In cases of death he must conduct the post-mortem section in the presence of an 
officer, handing in his report, with summary, to the commanding officer. 

7. The commanding officer will hand in a personal report to the King. 

(A supplementary order of December H, 17-26 adds: Regimental-barbers but not 
field-barbers shall be allowed to practice internal medicine and surgery among the civilian 
population, and to write prescriptions in apothecary shops; their evidence on bedside and 
post-mortem data shall be accepted in court.) 

The Infantry Regulations of March I, 1726 specify the old rule of the Brandenburg 
Army that no relief of the wounded could be attempted until victory had been sounded 
by the trumpets: "When the battle is over, each regiment shall seek out its wounded and 
bring them to a definite place where they can be bandaged and cared for; no wounded 
may be removed during battle." That this rule was not strictly in force is evidenced 
by the tact that Schmucker was wounded at Soor (1745) and Prague (1761) in line of duty. 
The same Instructions specify that "A military hospital shall be erected in the nearest 
town, to which the sick will be sent with a captain, a barber and two attendants from 
each battalion; should the army move on, a trusty non-commissioned officer shall be 
detached from each regiment, and supplied with money for the care of the patients. 



Eighteenth Century 143 

The patients will receive medicines from the field-apothecary who remains behind for 
the purpose. They are to be treated in hospital by special barbers, the troop-barbers 
having only to send patients to the hospital. The slightly sick may be transported by 
the baggage wagons but never within the marching columns. They are in charge of the 
captain who is personally responsible and must supply cooked food and bed covers (8 
per tent). The barber must never leave his company on the march, he is responsible for 
the light sick and receives the necessary medicines from the regimental barber. The 
latter receives from each company 200 Reichsthaler and fodder for 4 horses. Barbers are 
overseered by the Physician and the Surgeon General." In the same year (1726) the 
"medical-penny" (Medizin-Grosschen) was ordered to be deducted from the soldier's 
monthly pay for the use of the regimental barber, a species of tipping which was strongly 
disliked, as leading to peculation. An order of 1734 authorizes the construction of a 
great camp hospital for 600 patients. 

Frederick the Great 

Friedrich Wilhelm I was thus the creator of the mihtary establish- 
ment which was to accomphsh such remarkable things under his son, 
Frederick the Great. The father, a typical Prussian bear of the old 
regime, was practically in the hands of the Austrian envoy, Seckendorf , 
who broke up the queen's "double-marriage" project of an alliance 
with England by holding out to the king an illusory promise of the 
succession of the duchy of Jiilich and Berg. In consequence of this 
imbroglio the son and his sister Wilhelmine were treated by their 
father with a cruelty and barbarity which surpasses anything of the 
kind in history. As Frederick's life was more than once endangered 
by the parental rigors, he learned early to dissemble. There can be no 
doubt that, when he came to the throne, he had one definite object in 
view, to break the power of Austria and of the old Empire. The death 
of the Emperor Charles and the accession of Maria Theresa gave him 
his opportunity, and with scarce a word of warning he marched upon 
Glogau. The rich province of Silesia was easily acquired "by gentle 
pressure," for the native population favored the conqueror, much as 
the ]Milanese population favored Napoleon when his entry into that 
city destroyed the power of the Spanish viceroys. But Silesia once 
acquired, it was another matter to hold it. In the first and second 
Silesian campaigns (1740-45) Frederick served his apprenticeship in 
the art of war and secured for himself his conquests and a peace of ten 
years' duration (1748). INIeanwhile Maria Theresa occupied herself 
in mobilizing against him an unheard-of alliance consisting of Austria, 
France, Russia, Poland, Saxony and Sweden. In the Seven Years 
War (1756-G3) Frederick, as Carlyle puts it, found "his world of 
enemies all ccme." The interest of his career at this point is that, 
however unscrupulous his acquisition of Silesia in the first instance 
and although in no sense a soldier by original inclination, he succeeded. 



144 History of Military Medicine 

with no ally except England (in West Prussia), in keeping this world of 
enemies at bay with a valor and dexterity never equalled before or since. 

His principle of action was extreme rapidity of movement and a vigorous ofiFensive. 
At Kolin (1757), Grossjagersdorf (1757), Hochkirch (1758) and Kunersdorf (1759) he 
weathered disasters any one of which would have ended an ordinary commander. Reas- 
sembling new forces with extraordinary perseverance, changing base and front with a 
swiftness which Macaulay has likened to "the desperate bounds of a hunted tiger," he 
defeated the French, Austrians and Russians successively in the battles of Rossbach 
(1757). Leuthen (1757), Zorndorf (1758). Liegnitz (1760) and Torgau (1760). The year 
1761 found him facing ruin and at the end of his resources, when the death of the Czarina 
Elizabeth made the Russians allies instead of enemies. With these reenforcements he 
was able to conquer Silesia and end the war. The remaining twenty-three years of his 
life (1763-86) were spent in repairing the shattered remains of his kingdom. 

The man to whom all this happened was a child of his time and, like others of his 
time, a bundle of strange contradictions. Through his mother he was partly oi 
French extraction, educated by French refugees in Berlin, French in his tastes 
and inclinations. His conception of government is summed up in his famous sentence: 
"The prince is not the absolute master, but only the first servant of his people," and it 
was through his fidelity to this program, as well as his competence in grappling with his 
evil star, that he was accounted "the great" — le grand Frederic. Carlyle called him "the 
last of kings"; on his own showing he was the earliest public servant to give whole- 
time duty to the interests of a nation. 

Frederick's success in arms was due to his capacity for forming swift decisions and 
acting upon them; partly to the fact that he was his own self-constituted cabinet, general 
staflF and council of war and held all the reins of government. In his day the "art of 
war" consisted, not of principles but of cut and dried rules, and success was held to depend 
not upon men but upon methods; able commanders were therefore hampered by rules as 
well as by subordination to higher authority. Frederick's own rule of "vigorous offen- 
sive" cost him dear at Prague and failed him completely at Kolin and Kunersdorf. The 
end of the second Silesian campaign, which had used up the flower of his fine army, left 
him with a definite aversion to the costliness and uncertainty of war. The Seven Years 
War, fought at the end with inferior troops recruited by force from conquered regions, 
left him warped, hardened and embittered, with a clear vista of the long distance travelled 
between his spoiled, unsatisfactory youth and the chill isolation of a mean old age, as 
depicted in his droll verses: 

" Un vieillard glace par les ans, 
Froid. taciturne et phlegmatique, 
Dont le propos soporifique 
Fait balller tons les assistants." 

From his youthful days at Reinsburg, where he reported daily to 
his harsh parent about the health of his command, to his order issued 
one month before his death for a complete inspection of military hos- 
pitals, Frederick was perhaps the most active of all great soldiers in 
forwarding medical administration. His regard for medicine and 
physicians was small due to the fact that he got little relief from the 



Eighteenth Century 145 

many bodily ills that tormented him all his working life.^- But he saw 
clearly that to waste men was to court defeat, since for an army fighting 
in four separate theaters of war defeat always meant ravaging of his 
thinly guarded zone of the interior by hostile forces. — 

"En pere bienfaisant conduisez votre armee, ... 
Tant que Mars le permet il faut les menager." 

He usually made his own dispositions for the location of field dressing 
stations and general hospitals (in neighboring towns) and was merciless 
in reprimand if his orders were not obeyed to the letter. Thus at his 
instance Cothenius organized the field medical service for the Seven 
Years War with stationary general hospitals at Breslau, Glogau, Stettin, 
Dresden, Torgau and \Yittenberg, field hospitals (hopitaux amhulants) 
within call, and dressing stations, to be protected from enemy fire by 
locating them behind some convenient hillock or withinside a ditch, 
at the rear of the fighting columns. In siege operations a board booth 
or Blessirten-Depot was erected at the entrances to the breastworks, 
with standards one foot high for the imposition of litters; first aid was 
given by a regimental barber and four company barbers. Detachments 
for evacuation of the wounded from the field were always made from 
the regiments which had suffered most in battle (Instructions of 1748). 
Frederick's rule was first to relieve his own wounded, then those of the 
enemy, to whom he seems to have been most humane in his earlier 
campaigns. Thus after Hohenfriedberg he sent Lesser, Bouness, the 
field apothecary and 50 hospital surgeons to relieve the 7,000 Austrian 
and Saxon wounded at Striegau and visited them himself on June 5, 
1741. After Mollwitz concern for the wounded kept him 11 days at 
Ohlau. After Liegnitz, 500 dragoons were required to dismount to give 
saddle transportation to the w^ounded. On the bloody field of Kuners- 
dorf Frederick ordered rescue and bandaging of the wounded even 
before the end of the battle. As he was much given to doctoring on his 
own account, he insisted that his troops be purged and bled at intervals, 
treated dysentery with tartar emetic and ordered the use of vinegar in 



1' These were: gout, haemorrhoids, constipation, indigestion, asthma and the sequels of venereal 
and malarial infections. Like many people of small physique he was immoderately fond of the 
pleasures of the table and usually ignored the dietetic counsels of physicians, probably because the 
gouty diathesis persisted even during abstemious periods. His menu cards at Sans Souci were of 
portentous length and variety. Another great handicap for a general in the field was his emotional 
temperament. He was an exquisite musician, esteemed even today as a composer of chamber-music, 
turned out yards of indifferent French verses and was profoundly shaken by the deaths of near rel- 
atives. With this exaggerated sensibility he ran the gamut of such tremendous emotional experiences 
as the victory at Leuthen and the reverses of 1759-60. In time of peace, he was on duty from 4 to 5 
a. m. until nightfall. His exertions over stale-papers and drilling troops were, in Macaulay's phrase, 
"such as are hardly to be expected from a human body or a human mind." After death the body 
had shrunken to infantile proportions. 



146 History of Military Medicine 

water on marches in hot weather. In 1746 he presented 40,000 thaler 
to the Charite; founded the Invalidenhaus for instruction of medical 
pensioners or cadets in 1748; increased the number of garrison hospitals 
(1765) and the number of pensioner-surgeons, from 9 to 16 (1779). In 
July, 1786 one month before his death, he ordered a thoroughgoing 
inspection of all military hospitals, with a view to reorganization and 
better luck for the wounded. This reform was carried into effect during 
the reign of his successor, Friedrich Wilhelm II (1786-97). 

The Prussian Surgeons General 

In 1716 HoltzendorfiF was appointed Surgeon General, body-physician to the king 
and "director of all surgeons in the Prussian lands." Eight years later (17^4) Johann 
Theodor Eller (1689-1760), a skilled physician and chemist, was appointed Field Physician 
in Chief, presiding over all physicians (medici) and general medical practice in the army, 
as Holtzendorff presided over surgery and sanitation. This dual arrangement, effect of 
the old-time divorce between medicine and surgery, was yet regarded as a distinct advance 
for surgery, since surgeons now received the same training as ph\-sicians. It persisted 
throughout the 18th century, but was put to no particular test of merit until the first 
Silesian war. While obviously faulty, as tending to decentralize administration, it could 
have had little effect either way in Frederick's campaigns, for the latter himself made all 
dispositions for relief of the wounded, location of hospitals, etc., in his battle-orders. 
In 1746-7 J. H. Bouness was appointed to succeed Holtzendorff as Surgeon Generah 
and after serving through the earlier period of the Seven Years War, died in 1758. About 
the same time (1757-8) Eller, the Physician in Chief, was found to be incapacitated for 
service in this campaign by age and Christian Andreas Cothenius (1708-89) was appointed 
General Field Staff Physician (Generalfeldstabsarzt), with Ludolf (1757-63)" and Zinzendor 
(1763-89) as subalterns. Some-time before Bouness' death, and on account of enlargement 
of the army and the fact that separate detachments were fighting in several theaters of 
war, the king appointed Johann Leberecht Schmucker (1712-86) and Johann Ulrich von 
Bilguer (1720-96) as second and third surgeons general. Upon Bouness' death (1758) 
Schmucker, Bilguer and J. A. T. Theden (1714-97) became first, second and third sur- 
geons general respectively. When Schmucker died (1786) the arrangement became 
1. Theden, 2. Bilguer and 3. J. C. F. Voitus. When Bilguer died (1796) it became 1. 
Theden, 2. Mursinna, 3. Johannes Goercke (1750-1822). Finally when Theden died 
(1797) Goercke was appointed Chief of Military Sanitation and General Staff Surgeon, 
thus presiding over all medical, surgical and sanitary administration. Under Goercke 
the Collegium Medico-Chirurgicum became, in 1795, the Medico-Chirurgical Pepiniere, 
otherwise known as the Friedrich Wilhelms Institut, and after 1895, the Kaiser-Wiihelms 
Akademie. In 1798 a similar Collegium Medico-Chirurgicum had been established for 
the Saxon Army at Dresden, and in 1785 the Josephinum, or Medico-Chirurgical Academy 
of the Austrian Army, was established at Vienna. The arduous labors of the Prussian 
surgeons general in relief of the wounded in the different battles are given in detail by 
Koehler.'' Holtzendorff was instrumental in the foundation and extension of the Army 
medical college. Cothenius organized the field medical service for the Seven Years War, 
including the hospitals and the medicine chests. Schmucker, who was badly wounded 



"Koehler: op. cit., 129-218. Bilguer managed the care and treatment of the wounded at Ross- 
bach, Leutben, Kunersdorf and Torgau. Of the battle of Torgau he reports that out of 6.6] 8 
severely wounded, he lost only 653, while 5,557 recovered and 408 were invalided. 



Eighteenth Century 147 

at Soor (1745) and Prague (1761), acquired an extraordinary experience in military surgery 
in all the battles of the Silesian and Seven Years Wars, of which he has left a record in his 
valuable collections of surgical cases (1774r-82). These include a successful mastoid 
operation by staff -surgeon Jasser (1776). Bilguer achieved a European reputation 
through his dissertation of 1761 against reckless and ill-considered amputation, the bane 
of French surgery, then dominant. He was supported in his contention by the most 
eminent authorities of his time, and thus became the father of the conservative orthopedic 
surgery of Syme, Fergusson and Brodie. Theden wrote several books on military surgery, 
invented and manufactured elastic catheters and canulas, was a pioneer in hydrotherapy, 
invented a method of ventilation and introduced compressive bandaging. Goercke 
reorganized the Prussian Army medical department, and is essentially a figure of the 
Napoleonic period in energy and enterprise. 

The likenesses of all these officers in gala uniform or court dress have been preserved, 
either in the oil-portraits by Pesne and other court-painters of the period, or in the etchings 
and engravings of Chodowiecki and Moehsen. Holtzendorff and Cothenius are typical 
18th century men, with bold eyes and prominent features, like Handel or Hogarth. Eller, 
Theden and Goercke have something of the finesse which we associate with William Hunter 
or Benjamin Rush. Bilguer looks frosty and disagreeable and was, in fact, unpopular 
and ignored, while Theden's jubilee lasted five days. With the exception of Bouness, 
who may have had some Gallic infusion, all have the preternatural gravity of the Northern 
races. 

Battle-losses in Frederick's Campaigns 

As given by Carlyle, and others the losses Ln the principal battles of the first and 
second Silesian wars were as follows: 

MoUwitz (April 10, 1741): Prussians, 4,613; Austrians, 4,410 (killed, wounded and 

missing). 
Chotusitz (May 17, 174£): Prussians, 5,000 (1.905 killed); Austrians, 7,000 (1,052 

killed). 
Hohenfriedberg (June 4, 1745): Prussians, 5,000; Austrians and Saxons, 9,000 and 

7,000 taken prisoners (Saxons, 33 officers, 2,419 men killed; 90 officers, 

825 men wounded). 
Soor (September 30, 1745): Prussians, 1,500 killed, 3,000 wounded out of 18,000; 

Saxons, 27 killed, 474 wounded. 
Kesselsdorf (December 15, 1745): Prussians, 1,604 killed, 3,158 wounded; Saxons, 

58 officers, 3,752 men killed and wounded. 

In the Seven Years War the Prussians suffered 8 defeats out of 16 major battles 
and lost 190,000 soldiers out of 218,000 and 33,000 of the native population. Their 
allies, the English, lost 100,000, the Austrians, 140,000, the Russians 120.000, the French 
200,000, the Swedes 25,000 and the armies of the old Empire 20.000. The losses in 
the principal battles were: 

Lobositz (October 1, 1756): Prussians, 3,308; Austrians, 2,984. 

Prague (May 6, 1757): Prussians. 11,740 killed and wounded, 1,560 prisoners (10.80 
per cent total strength); Austrians, 10,000 (14.8 per cent) and 4,275 prisoners. 
Kolin (June 18, 1757): Prussians, 6,710 killed and wounded (including 320 officers) 
and 5,380 prisoners out of 34,000; Austrians, 8,000 (including 1,500 prisoners) 
out of 53,500. 
Grossjagersdorf (August 30, 1757): Prussians, 3,000; Russians, 9.000. 
Rossbach (November 5. 1757): Prussuins, 165 killed. 376 wounded; Austrians and 
French (French, 3,650 killed and wounded, 6,220 prisoners). 



148 History of Military Medicine 

Leuthen (December 5, 1757): Prussians, 1,141 killed, 5,118 wounded, 85 prisoners out 
of 30,000; Austrians, 3,000 killed, 7,000 wounded, 12,000 prisoners out 
of 80,000. 

Zorndorf (August 25, 1758): Prussians, 11,385 (3,680 killed) out of 36,000; Russians, 
21,529 (6,406 killed. 11,867 wounded) out of 42,000. 

Hochkirch (October 14, 1758): Prussians, 9,450 (1,190 killed and missing, 5,381 
wounded); Austrians, 8,614 killed, wounded and missing. 

Kunersdorf (October 10, 1759): Prussians, 20,720 (48.2 per cent) out of 43,000; Aus- 
trians and Russians, 15,700 out of 90,000 (Russians, 2,614 killed, 10,863 
wounded). 

Liegnitz (August 15, 1760): Austrians, 10,000; Prussians, 1,800. 

Torgau (November 3, 1760): Prussians, 13,120 (30 per cent) out of 44,000; Austrians, 
11,260 (17.3 per cent) out of 65,000. 

War of the Austrian Succession 
(1740-48) 

The breach made by Frederick the Great in the fabric of the Holy 
Roman Empire soon set the whole world by the ears. Nearly all the 
great powers began to cavil at the doctrine of Pragmatic Succession, i.e., 
the right of Maria Theresa to the imperial throne. In the War of the 
Austrian Succession (1740-48), which ostensibly challenged this doctrine 
but actually aimed at the destruction of the old Austrian Empire, 
there was fighting all over the globe. For this cause, as Macaulay said, 
the wild Highlanders fell at CuUoden, the devoted column at Fontenoy 
was destroyed, "black men fought on the coast of Coromandel and red 
men scalped each other by the Great Lakes of North America." The 
peace of Aix la Chapelle (1748) left Silesia in the hands of Frederick. 

The first five years of the War of the Austrian Succession were 
occupied mainly with Frederick's first and second Silesian Campaigns. 
During this war England sided with Maria Theresa, as it was to side 
with Frederick in the Seven Years War. In the interval between the 
two Silesian wars an English army under George II entered Germany 
and defeated the French at the battle of Dettingen on June 27, 1743. 
Frederick abandoned the French who, although driven out of Austria, 
defeated the Austrians, English, Dutch and Hanoverians at Fontenoy 
on May 11, 1745. A remarkable feature of this war was guerilla raiding 
and bushwhacking by hordes of murderous Croats, Hungarian Pandours 
(Tolpatches) and huzzars. These " Pandourades " spread lawlessness 
and rapine through whole kingdoms and were bitterly resented by the 
people. 

At the battle of Dettingen there was present a keen-sighted Scotch 
officer who, through the Earl of Stair, brought about an agreement with 
the Due de Noailles that both the French and English military hospitals 
were to be regarded as neutral and immune from attack during the 



Eighteenth Century 149 

engagement. This was Sir John Pringle (1707-82), who had been made 
Surgeon General of the British Army one year before (1742) and served 
in that capacity until 1758. Pringle's account of this temporary Red 
Cross agreement may be given in his own words: 

"Till then it had been unusual for the security of the sick (when the enemy was near) 
to remove them a great way from the camp; whereby many were actually lost before they 
came under the care of the physicians. But the Earl of Stair, my illustrious patron, 
being sensible of this evil, when the army was encamped at Aschaffenburg, proposed to 
the Duke de Noailles (of whose humanity he was well assured) that the hospitals on both 
sides should be considered as sanctuaries for the sick, and mutually protected. This was 
readily agreed to by the French General, who took the first opportunity to show a proper 
regard to his engagement. For when, after the battle of Dettingen, our hospital was at 
Feckenheim, a village upon the Maine, at a distance from the camp, the Duke de Noailles, 
having occasion to send a detachment to another village, upon the opposite bank, and 
apprehending that this might alarm the sick, he sent to acquaint them, that, as he knew 
the British hospital was there, he had given express orders to his troops not to disturb them. 
This agreement was strictly observed on both sides during the campaign, and though it 
has been since neglected, yet it is still to be hoped that on future occasions the contending 
parties will make it a precedent."" 

In 1752 Pringle published his Observations on Diseases of the Army, 
the most important text-book on military medicine of the time, in which 
are laid down the true principles of military sanitation and the ventila- 
tion of hospital wards. Pringle was one of the pioneers of the antiseptic 
idea, showed that jail fever and hospital fever are one and the same, did 
much for the better ventilation of ships, barracks, jails and mines, 
correlated the different forms of dysentery and gave the name influenza 
to that dread disease. This work, the source-book of all subsequent 
writers, was followed by Van Swieten's book on Camp Diseases (1758) 
and Richard Brocklesby's Observations on Military Hospitals (1764). 
In the Navy, James Lind's Essay on the Hygiene of the Sailors (1757) 
became a classic, especially in relation to the prevention of scurvy. 

The siege of Metz (1552) and the battle of Dettingen (1743) were 
by no means the only instances of a temporary Red Cross agreement. 
No less than five, between 1743 and 1864, were placarded at the Berlin 
exposition of military medicine in 1914. 

During the early part of the century constant attempts were made 
to arrange some disposition of the wounded which would not interfere 
with military operations. At the battle of Fontenoy (1745) the 
wounded were treated on the front line by regimental surgeons, then 
collected at ambulance stations, where major operations were performed, 
and finally evacuated to hospitals in cities farther back, an almost 
perfect system. 



'• Pringle: Observations on the Diseeises of the Army, Londou, 1752, preface, pp. vi 



150 History of Military Medicine 

Heizmann's account of this important episode^^ may be quoted in full : 
"The contending forces, allied English, Dutch, Hanoverians and Austrians, 55,000, 
and the French, 60,000, were organized very much alike: foot battalions of five companies 
containing 100 to 140 men each, two to four battalions making a regiment numbering 1,000 
to :2,700 men, the English battalions being slightly largest; cavalry, in squadrons of about 
100 men each. As at this time each infantry regiment had a surgeon and mate or assistant, 
it is estimated that the Allies had about forty regimental medical officers, the French as 
many; the cavalry of both armies had none. There was on both sides a small number of 
physicians, one usually to a garrison of about 10,000 men, and army surgeons. The 
infantry were armed with flintlock muskets and bayonets, the sword having been aban- 
doned about this time, and they worked the fieldpieces of artillery, the largest mentioned 
being a battery of six 16-pounders on the bank of the River Scheldt opposite the field, 
to cover the retreat of the French King. All arms were engaged at one time or another, 
the artillery opening the battle, and at the critical moment, supported by cavalry, saving 
the day for the French, an occurrence said to have been the first combination of the two 
arms in history. 

With the village of Fontenoy toward the right of the French centre, the length of 
the line that bore the brunt of the battle was about 1,200 yards, and the width, of what 
was practically a closed field, was 2,000 yards. The point where the English and Han- 
overians massed their attack was on the left of the village, including it eventually, and 
it was here that the terrible slaughter of the French infantry nearly won a victory for the 
allies. Surgeons were posted on the first line, as is proved by the fact that while the 
English were advancing on the regiment stationed nearest Fontenoy, the French lieu- 
tenant-general Luttau.x was wounded, and his aide implored him to have his wound first 
dressed before going to report to the king. The regiments of Hainaut and Dillon were, in 
the beginning, on the French left, and which, moving toward the centre to stay the English 
by an attack in the flank, lost heavily. It is stated by Boucher that on the field itself 
amputations were performed on wounded of these regiments, it is inferred, at the ambulance 
hospitals, which were, at the farthest, about 2,000 yards from the front line. After the 
battle these ambulances were evacuated and the wounded carried on caissons and carts 
to cities in the rear, principally to Lille, 16 miles, and Douai, 20 miles distant, where an 
immense number of surgical operations were performed at hospitals established for the 
purpose, the civil hospitals, churches and private houses being used. A battle begun with 
an exchange of fencing master's compliments ought to have terminated by an exhibition 
of practical philanthropy, and Voltaire says that in these hospitals no comfort was wanting 
for the wounded French or their prisoners. The zeal of civilians and soldiers was such 
that thf surgeons were obliged to interfere, and the hospitals were so well managed that 
ofiBcers preferred to be treated there. The Allies carried 600 wounded twenty miles, to 
Ath, where a hospital was established in the casernes; they left 1,200 in the hands of the 
French, who had of their own 4,000. Here, then, at Fontenoy May 11, 1745 wounded 
soldiers were treated on the first line by regimental surgeons; they were collected at ambu- 
lance stations where capital operations were performed, then transferred to hospitals 
prepared for them in near cities and, when these became overcrowded, to cities farther 
away. A few months after this battle Maillebois conducted an army into Italy, his chief 
physician being Baron who was subsequently dean of the Faculty of Paris, and in nearly 
every daily order for marching and camping is designated a place for the hospital ambulant, 
usually on the march in rear of the artillery with the treasure and provisions. The day 
before the battle of Bassignano, September 27, 1745, three ambulance hospitals were 



I'Heizmann: Ann. Med. History, N. Y., 1917-18, I, 299-300. 



Eighteenth Century 151 

organized, one for each column, and ordered to take station at villages, each about 1,200 
yards in rear of the line of battle on the river Tanaro where an engagement was expected 
Two of these hospitals actually united opposite the centre of the line which covered ground 
about 6,000 yards long. And in the "Art of War," by the Marechal de Puys6gur, pub- 
lished in 1749, a map for illustration shows the ambulance about 2,500 yards in rear of 
the first line. Excepting an untried project of Ravaton very little improvement on 
Randby's outline and Bagieu's account took place subsequently until Larry and Percy 
made their names immortal, not only for the invention of details to rapidly relieve and 
remove wounded soldiers during battle on a scale never equalled, but for their inestimable 
contributions to operative military surgery." 

Among the surgeons' mates on the naval expedition of Admiral 
Vernon to Carthagena (1741) was the Scotch novelist Tobias Smollett 
(1721-77), who gives the following account of the status of the sick and 
wounded who survived the storming of Fort Lazar^^: 

"As for the sick and wounded, they were next day sent on board the transports and 
vessels called hospital-ships; where they languished in want of every necessary comfort 
and accommodation. They were destitute of surgeons, nurses, cooks and proper provision; 
they were pent-up between decks in small vessels where they had not room to sit upright; 
they wallowed in filth; myriads of maggots were hatched in the putrefaction of their sores, 
which had no other dressing than that of being washed by themselves with their own 
allowance of brandy; and nothing was heard but groans, lamentations and the language of 
despair, invoking death to deliver them from their miseries. What served to encourage 
this despondence was the prospect of those poor wretches who had strength and opportunity 
to look around them; for there they beheld the naked bodies of their fellow-soldiers and 
comrades floating up and down the harbour, affording prey to the carrion-crows and sharks 
which tore them in pieces without interruption, and contributing by their stench to the 
mortality that prevailed. 

"This picture cannot fail to be shocking to the humane reader, especially when he is 
informed that while those miserable objects cried in vain for assistance, and actually 
perished for want of proper attendance, every ship of war in the fleet could have spared a 
couple of surgeons for their relief; and many young gentlemen of that profession solicited 
their captains in vain for leave to go and administer help to the sick and wounded. The 
necessities of the poor people were well known; the remedy was easy and apparent; but 
the discord between the chiefs was inflamed to such a degree of diabolical rancour that 
the one chose rather to see his men perish than ask help of the other, who disdained to 
offer his assistance unasked, though it might have saved the lives of his fellow-subjects." 

War of the Bavarian Succession (1778-79) 

In 1777 Maximilian Joseph, Elector of Bavaria, died without issue. 
The disputes about the succession following this event and the fact 
that Emperor Joseph II of Austria assumed possession of the Elector's 
lands occasioned a brief war, into which the aged Frederick the Great 
was reluctantly drawn. In July, 1778 he crossed the Bohemian border 
at the head of an army of 100,000 men, but there was no fighting of 
consequence and the difficulties were resolved by the treaty of Teschen 



1' Smollett: Miscellaneous Works. Edinburgh, 1806, IV, 445-469. Cited by Carlyle. 



152 History of Military Medicine 

(May 13, 1779). The principal interest of this brief campaign is that 
almost for the first time Frederick's forces suffered materially from 
disease, with an enormous mortality from dysentery and typhus fever. 
Of his first Silesian army he lost by disease 9,300 men; of the second, 
numbering 69,113, 5,200 died in six months, while the Saxon army of 
22,000 lost only 48 in the same period. Frederick brooded long over 
these losses and on July 10, 1786 he instructed staff surgeon J. G. Fritze 
to make a thorough inspection and critique of Prussian military hospitals, 
resulting in Theden's Regulation of September 16, 1787 which remained 
in force up to the Instructions of October 2-3, 1809. 

Military Surgery in the 18th Century 

"At the beginning of the 18th century," says Billings, "the only city 
in which there were any special opportunities for the study of surgery 
was Paris. There was no place for the barbers or the barber-surgeons 
in the Universities of Europe, and they had no institutions of their own 
in which any teaching worthy of the name could be obtained. Many 
of them had learned something in the camp or on the battlefield, which 
was the great practice school for surgeons, as it had been for three 
centuries. "^^ The leading French surgeon of the time was Jean Louis 
Petit (1654-1750), inventor of the screw tourniquet and the first to open 
the mastoid (1736), and to whom Frederick the Great applied in 1744 
for a selection of French surgeons to serve as officers in the Prussian 
army. Desault, the teacher of Bichat, Dionis, Brasdor, Anel, Littre, 
La Peyronie, David, Le Cat, Chopart and Daviel are among the promi- 
nent French names of the period. In England Cheselden, Pott and 
John Hunter were the leading figures; in Germany Heister, Bilguer, 
Gabriel Senff, C. C. von Siebold and A. G. Richter. 

In the first half of the 18th century belief in the weapon salve and the sympathetic 
powder disappeared, and wound-treatment became simpler. Hemorrhage was treated 
with styptics, of which Heister recommended lycoperdon powder and "the sharpest 
brandy," and Bilguer the sponge, alcohol and turpentine. Cauterization of blood- 
vessels in amputation was still practiced by Purmann in 1710, while ligation of arteries 
(isolated by the forceps), although opposed by J. L. Petit, is described and recommended 
in Heister's Surgery (1718). In gangrene Bilguer, who was chary of amputation, ligated 
the principal vessel in the healthy part and then cut down. In ordinary cases he is said 
to have got unusually good results by free incisions. Wounds were still stuffed with charpie 
moistened with wine or brandy, and if suppuration threatened, such antiseptics as corro- 
sive sublimate in chalk solution {aqua phagedaenica), balsam of Peru, tincture of myrrh, 
camphor or hot turpentine were sometimes employed (Koehler"). While it is to the credit 
of Bilguer, Schmucker, Theden, and Mursinna that they substituted dry bandages or 
bandages moistened with plain water for the dubious and complex salves and plasters. 



" J. S. Billings: History of Surgery, New York , 1895, 69. 



Eighteenth Century 153 

yet, as Billings says, the other surgeons of the time "kept on prescribing and using their 
oils, ointments, plasters, vulnerary drinks, etc.," because these remedies, devised and 
prepared by themselves, increased their fees. "Charges were made for the remedies and 
not for the visits." Almost every prominent surgeon had a special arquebusade or vul- 
nerary water the secret of which was jealously guarded. Although Purmann and Voitus, 
along with the English and French surgeons, declaimed against the unethical foible of 
secret remedies, they were very popular in Germany. Schmucker had a private eye-water 
and Theden a secret arquebusade. The probing of woimds, so vigorously opposed by 
Felix Wiirtz, continued to be practiced until Stromeyer did away with the probe and 
Semmelweis, Pirogoff and Lister exposed the evil consequences of dirty fingers. Trephin- 
ing as a routine procedure in head injuries was upheld by Le Dran, Mareschal, Pott, 
Bilguer and Mursinna, and opposed by Desault, John Bell and to some extent by Heister. 
Purmann, who trephined 40 times in 12 years' experience, followed the old Hippocratic 
rule of operating for pressure symptoms, i. e., vomiting, aural hemorrhage, loss of con- 
sciousness and con\'ulsions resulting from depressed or splintered fractures, with sub- 
cranial hemorrhage; in headache, epilepsy, vertigo, etc., only when of long duration, 
Heister limited the operation to open head injuries and extradural hemorrhage. Schmucker 
and Theden treated most cases by cold compresses. At the siege of Schweidnitz (1762) 
Schmucker had a special hospital for head injuries, in which he classified and studied 
his cases. As stated, Bilguer was the great opponent of reckless amputation (1762) or 
what Frederick the Great styled "lopping off arms and legs by the dozen (1781)." The 
monograph, although in direct opposition to the teaching of Le Dran, was translated into 
all languages. Bilguer's six indications were: gangrene, bad mangling of the limb with 
threatened fatality, marked contusion with multiple fracture, injuries of the great 
vessels, incurable caries of bone and cancer. Charles ^Tiite first excised the head of the 
humerus in 1768, which was repeated by Bent in 1771, while the same operation was 
performed nine times by Percy, of Napoleon's army, during 1792-5. In 1793 Goercke 
resected the elbow joint for gunshot wound. Exarticulation or "amputation in the joint" 
was favored by Schmucker for the shoulder and hip, and rejected in the case of elbow and 
knee, since the tissues in these parts were not adequate for a suitable flap. Among the 
bolder operations of the 18th century were the first laparotomy for localized appendicitis 
by Mestivier (1759), John Warren's amputation of the shoulder-joint (1781), Abernethy's 
ligations of the external iliac (1796) and common carotid (1796), and the laparotomies 
of John Bard (1759) and William Baynham (1791-9). 

The most original scientific surgeon of the 18th century was John 
Hunter (1728-93) of Long Calderwood, Scotland, who gained his re- 
markable knowledge of gunshot wounds while on duty as senior staff 
surgeon on the Belle Isle expedition (1761) and in Portugal (1763), 
became deputy surgeon-general of the British Army in 1786 and was 
appointed surgeon general and inspector of regimental infirmaries in 
1791. Hunter was the founder of experimental surgery and surgical 
pathology and a remarkable pioneer in comparative physiology and 
experimental morphology. 

He first described shock, phlebitis, intussusception, hard chancre and chancroid, 
introduced the principle of ligating high up in the healthy tissues for aneurism (1786), 
made many discoveries in human and comparative anatomy and through his great treatises 
in dentistry (1771), venereal disease (1786), inflammation and gunshot wounds (1794), 
created a new epoch in surgery. Like other ofiicers of scientific bent he was but an indif- 



154 History of Military Medicine 

ferent military administrator and was described by Robert Jackson as "a man of an 
original mind and considerable discernment, but too little acquainted with military 
operations in the field to foresee everything that was likely to occur in military service, 
and provide on all occasions, from his own soiu-ce of knowledge, the best means of remedy. 
He considered the cure of diseases, whether by manual operation or the use of internal 
remedies, as the proper business of a medical man destined for the service of the army." 

Military Hygiene in the 18th Century 

The personal hygiene of the soldier, his clothing, food, shelter, 
hospitalization and general sanitary welfare were favorite themes of 
study with the military authorities of the 18th century and came to be 
summarized in compact treatises such as those of Pringle (1752), 
Brocklesby (1764), Monro (1764), Colombier (1772) and others. 

The Rioeries of the Marechal de Saxe (1738) enlarges particularly upon clothing, foot- 
gear, rations, bathing, amusements and general creature comforts. Uniforms, supplied 
as a source of profit by officers in France until 1729 and in England until 1858, were at 
first theatrical, unsanitary and poorly adapted to heat or cold. Saxe discarded white 
gaiters, as suitable only for parades, linen stockings, as leading to foot trouble, and garters 
as constricting the circulation, substituting low-heeled leather shoes, worn upon the bare 
feet, with puttee-like arrangements, surmounted by leathern breeches buttoned above the 
knee; the coat was a loose-fitting sack, extending to the thighs or knees, the head-dress 
being a casque surmounted by a panache of plumes. The Comte de Sainte Germain, 
Minister of War, proposed a cloth coat, breeches of tricot, a vest of white cloth and a 
linen girdle." Some 20 odd specimens of uniforms of the different arms, including just- 
aucorps and frock-coats, riding brjeches, long riding boots, cravats, cuirasses and three- 
cornered hats, were exhibited at Dresden in 1911. Greasing or oiling the hands and feet 
against cold were recommended by Saxe, while Meyserey recommended gloves fo fur or 
thick linen, high leather shoes (brodequins) and linen quilts. In the matter of rations 
Frederick the Great said that the stomach is "the basis and foundation of all military 
operations". In 1751 the French ration was 28 ounces of bread and half a pound of meat 
daily, except on Fridays. Saxe insisted that the meat should be served partly as a soup 
at mid-day and as a roast in the evening. Bread was frequently adulterated at this 
time, and such bread was regarded as deleterious to wound healing. Unripe or spoiled 
fruits and unboiled water were common sources of illness. The Roman custom of adding 
a few drops of vinegar to potable water was followed by Frederick and Napoleon. Wine, 
beer and cider were permitted in moderation, but French government placards against 
brandy canteens existed even in 1683. Wines plastered with litharge or other lead salts 
were true poisons. Rations of tobacco were ordered by Louis XIV (1672-1683). Singing 
and jollity on the march, theatrical performances in camp, etc., were also regarded by 
Saxe as excellent for morale and the cheerful disposition necessary for good soldiering. 
Sites of camps and of latrines were chosen with care, and directors of hospitals were 
required to wash and whitewash the walls to destroy vermin. French orders of 1701, 
1728 and 1752 required daily cleaning of the wards before wound dressing and after 
the evening meal. The courts, staircases and corridors were swept once daily and the 
kitchens and bakeries of the hospital were also to be kept scrupulously clean. In spite 
of all this hospitals continued to be dirty, overcrowded and, in consequence, hotbeds of 
infection. In 1777-89 the English philanthropist, John Howard (1726-90), published his 
epoch-making investigations of prisons and lazarettos, which had much to do with the 
suppression of typhus fever, by demonstrating its transmission through overcrowding 



Eighteenth Century 155 

and filth. In 1788 Jacobus Rene Tenon published a memoir of equal moment on the 
hospitals of Paris, containing his celebrated description of the Hotel Dieu. This, the most 
mportant landmark in the history of hospital administration, was instrumental in bringing 
about many important and much needed reforms in Paris, Vienna, Moscow and other 
cities. At this time even hospital service by physicians was sometimes regarded as a 
"sentence of death" (Baas). Stephen Hales (174S) and Theden invented methods of 
artificial ventilation, while Pringle and Brocklesby did much to prove that plenty of fresh 
air in spacious hospital wards and wide dispersion of the patients in such wards or in 
separate tents were potent factors in lessening the mortality from communicable diseases. 
Thus there was but little mortality in the temporary open sheds used for the sick evacuated 
to the Isle of Wight in 1758, or the small hospital huts introduced by Brocklesby in 1760 
and again employed in the camp at Winchester in 1761, although the patients were some 
times exposed to cold and rain. In the Flanders campaigns of 1743-48 it was also observed 
by Pringle that sickness increased in camps and hospitals located on damp low-lying 
sites, while detachments quartered in high and dry localities furnished hardly any quota 
to hospital. In the Low Countries pleurisy and pneumonia, rheumatic affections, inter- 
mittent and inflammatory fevers, diarrhoeas and dysenteries were responsible, in the 
order named, for the highest disease incidence and mortality. In 1762 the following excel- 
lent "Regulations for Hospital Management" were proposed by Robert Gordon, a military 
surgeon attached to Winchester Camp, and approved by Brocklesby:^* 

1. A sergeant will be appointed to the hospital to preserve good order and regularity 
among the sick. He will provide all necessaries ordered by the surgeon, keep an account 
of the same open to the inspection of every officer, to see that nothing is brought out of 
the hospital except by his order, especially strong liquor. Every night at tattoo he is 
to call a roll of the sick, lock the door, and be answerable that none stir out, but go to bed 
immediately. 

2. The pay-sergeant of each company to pay into the hands of the hospital-sergeant 
every day the subsistence of his men, with all proper necessaries ordered by the surgeon. 
This account to be settled by the hospital-sergeant with the surgeon every week, and by 
the surgeon with the paymaster every month. 

3. Two orderly men to be appointed by the surgeon, to assist in taking care of the 
sick at hospital, who are to take their orders from the surgeon or the sergeant of the 
hospital, which they are punctually to obey. 

4. No man on any pretence of illness to be excused parade or any other duty, unless 
reported to the surgeon, and when reported the sergeant or corporal of his company is 
mmediately to send him to hospital when taken ill; if unable to walk, he is to be carried. 

5. After this order every man found sick in his quarters, unless by leave of the surgeon, 
will be severely punished; any sergeant or corporal found remiss in sending men to hospital 
immediately, when taken ill, will be assigned or brought to court-martial, and degraded, 
for neglect. 

6. Every man ordered to hospital to take with him his knapsack and necessaries and 
deliver them to the hospital-sergeant, who is to take them in charge and deliver them to 
the man when he recovers. 

7. If any man in hospital is guilty of irregularity, or refuses to comply with orders of 
the hospital-physician or sergeant, or makes any disturbance, or shall misbehave himself 
to the sergeant or his superior officer of the hospital, he will be severely punished. 

8. \ sentry is to be posted at the hospital door during the morning at the same time 
as at head-quarters, where instructions as to his duty will be put up at the door in writing. 



'8 R. Brocklesby: CEconomical and Medical Observations, London, 1864, 81-85. Cited by Gore, 
op. cit., 94-96. 



156 History of Military Medicine 

and read to the relieving sentry by the corporal of the guard at every mounting. Signed 
by the Colonel to enforce the necessary obedience. 

The orders for the sentry were that no patient was to pass beyond his own guard with- 
out a ticket from the surgeon; that no strong liquors were to be brought out of hospital. 
He was to take care of the fire, and see that no mischief was done to the house, that no 
dirt was thrown near his post or anyone suffered to enter the hospital without cleaning or 
scraping his shoes, and he was to prevent too many people of the camp or heath from 
paying frequent or long visits to the hospitak 

Brocklesby whose treatise of 1764 is the best book on sanitary administration in the 
century, also recommended: 

1. To avoid all manner of nastiness in every encampment. 

2. To pay frequent attention to the shifting and covering in of all the privies in the 
rear as soon as, or before ever they begin to be offensive to those who are a few yards 
distant. 

3. Always to keep as few possible sick in one room or under the same roof. 

4. To air and turn the straw on which the men lie in their tents twice or thrice a week 
in summer encampments. 

5. All buildings selected for military purposes to be as lofty and spacious as possible. 

6. The physician's power in a military or camp infirmary to be as peremptory as that 
of the commanding officer over all his corps out of that place. 

The physician was advised to manifest, in all his management of the hospital, an 
inviolable attachment to method in all things; to fixed hours in dressing the wounded, 
visiting the sick, having their medicines prepared and proper medicated drinks, without 
which fixed methods, whenever there were many sick, they would often suffer very much. 

Prostitution in the armies of continental Europe^' ultimately resolved 
itself into toleration of soldiers' "wives" on the theory that fewer men 
deserted if domesticated in regiments by women, and that such women, 
as constituting a species of sexual canteen, were less liable to transmit 
venereal disease. Prussian orders of June 1, 1713 and February 28, 
1714 stipulate that soldiers' wives may occupy quarters but have no 
claims to light, fuel, food, beds, etc., and the same note is sounded in 
Austrian Field Regulations of March 12, 1759. An edict of Friedrich 
Wilhelm I of Prussia limits the number of married soldiers to one-third 
of the command. A Prussian circular of August 23, 1733 permits 10 
per cent of a company to be married. In Frederick's march on Glogau 
(1740) the first casualty was the accidental drowning of a soldier's 
wife "of the Bredow regiment" (Carlyle, XII, ch. II). In the Saxon 
army of 1790 there were 20,000 illegitimate children to 30,000 men. 
Carnot in 1793 drove 3,000 women away from the barracks at Douai 
because the diseases transmitted by them "killed ten times as many 
men as enemy fire." Archenholz, in his History of the Seven Years 
War, tells of the large number of loose women, even in officers' quarters, 
and of the adoption of the French custom of passing such women, 
stripped to the waist, through two rows of soldiers who belabored them 



WW. Haberling: Ztschr. f. BekAmpf. d. Geschlecbtskr, Leipz., 1914. XV, 326-332. 



Eighteenth Century 157 

with switches. This was forbidden by the French orders of 1750 in 
which camp followers were to be cured of any diseases in hospital before 
commitment to the work-house. In spite of the many orders and of 
such expedients as "tented brothels" (Hurenzelte), the problem of 
limiting prostitution in large commands was as difficult as among the 
civilian population. Venereal infection was very widespread at this 
time. ^Yhen any of the gentry went into seclusion it was assumed 
that they were undergoing "the tub-fast and the diet." The increase 
of the neurotic in modern times has been attributed to the fact that the 
ancestors of the civilized were, like Metchnikoff's ape, "syphilized." 
The main thesis of Dean Swift's satirical "Argument" against the 
abolishing of Christianity (1708) was that the clergj' were best adapted 
to propagate healthy specimens of the race, as being less exposed to 
debauchery and disease. 

The American Revolutions^ 

The history of our Army Medical Department begins auspiciously 
in the Colony of Massachusetts Bay where, on May 8, 1775, the Provin- 
cial Congress ordered that a committee of physicians, appointed by the 
Congress, examine as to professional qualifications all persons recom- 
mended for appointment as surgeons to the several regiments by their 
commanding officers. Prior to this date medical aid in such engage- 
ments as Concord fight or Lexington had been voluntarily rendered by 
private physicians, who later sent in bills for services rendered. These 
physicians had no military status or authority whatever. As described 
by Thacher in his Military Journal of 1775 the examinations set in 
anatomy, phj'siology, surgery and medicine, were so rigorous that a 
perspiring candidate, when asked how he would promote sweating in 
a rheumatic patient, replied: "I would have him examined by a medical 
committee." 

After the battle of Breed's Hill hospitals were established at Cambridge, Watertown, 
Roxbury and elsewhere, with regulations drafted by the Congress, and appropriate 
warrants were issued to the hospital surgeons and mates. At this time the inchoate 
medical establishment of the Army was termed "The Hospital." On July 19, 1775 
the Colonial Congress in Philadelphia appointed a committee to consider ways and 
means of establishing the Hospital, a project strongly recommended by Gen. Washington 
on July 21. On July 27 Congress reported a bill for its organization, which was adopted, 
with Dr. Benjamin Church as Director General and Chief Physician, at four dollars per 
diem. Three months later (October 3, 1775) Church was tried by a couincil of war, for 
treasonable correspondence with the enemy, and imprisoned. On October 17 Dr. John 
Morgan was appointed to succeed him. Morgan, who had been instrumental in organizing 



»» H. E. Brown: The Medical Department of the United States Army from 1775 to 1873. Wash- 
ington, 1873, 1-86. W. O. Owen: The Medical Department of the United States Army during the 
Period of the Revolution, New York, 1920. 



158 History of Military Medicine 

the Medical Department of the University of Pennsylvania (1765), rendered most valuable 
services up to his unjust dismissal from the Army on January 9, 1777. On April 11 
Dr. William Shippen was appointed to succeed him. Meanwhile Morgan had published 
his spirited Vindication (1777) and received a tardy, but handsome exoneration at the 
hands of Congress on June 12, 1779. Morgan's dismissal was due in part to the increasing 
sickness among the troops, the difficulty in supplying them with medical supplies, but 
principally to the fact that Drs. Stringer, Shippen and others had been appointed to 
regional directorships, with the usual division and decentralization of authority and the 
jealousies naturally resulting therefrom. At the time of Shippen's appointment the 
Prussian and English plan of medical administration was in full swing, with Physicians, 
Surgeons and Deputy Directors General and a fourth staff officer dubbed "Physician and 
Surgeon General of the Army" in each of the Middle, Eastern and Northern Departments. 
These four "generals" were of vague status but apparently coeval with the Director 
General of "The Hospital." All this led to further contretemps such as the resignation 
of Benjamin Rush in the trying Valley Forge period (1778) and the court martial and 
acquittal of Shippen (1780). There resulted the Congressional bill of September 30, 
1780 with the reelection of Shippen as Director General and the appointment of John 
Cochran as "Chief Physician and Surgeon." Finally, at the end of the War, Congres- 
sional Acts of July 25, 1782 and -January 1, 1783 assigned a Director and Deputy Director 
to the Hospital Department. During the war Washington manifested the keenest interest 
in the welfare of the medical establishment, particularly in his instructions to Morgan for 
the removal of the Hospital to New York (April 3, 1776), his letters to John Hancock on the 
dubious and jealous character of the regimental surgeons and their intrigues against the 
Hospital (1776-77), and his letter of approval of Shippen's and Cochran's plan for reorgani- 
zation (February 14, 1777). The animus of Congress had been against centralization, 
and although the reorganization acts of July 17, 1776, April 7, 1777, February 6, 1778, 
and July 21, 1780, were progressive in spirit, it took a long time to reach the final stage. 
Our first hospital regulations were drafted by Morgan after conference with Washington 
and the regimental surgeons, and published in July, 1776. In March, 1778 Baron von 
Steuben, a former aide of Frederick the Great, arrived in the country to offer his services 
to the government. In May, 1778, at the instance of Washington, he was appointed 
Inspector General of the Army. Steuben's work in improving the organization, drill 
and discipline of the army, quietly and unobtrusively done, was of the highest value. 
In 1780 he drafted and published our first Army Regulations, of which the following 
relates to the medical establishment: 

Of the Treatment of the Sick 

There is nothing which gains an officer the love of his soldiers more than his care of 
them under the distress of sickness; it is then he has the power of exerting his himianity 
and making their situation as agreeable as possible. 

Two or three tents should be set apart in every regiment for the reception of such sick 
as cannot be sent to the general hospital, or whose cases may not require it- And every 
company shall be constantly furnished with two sacks, to be filled occasionally with 
straw, and serve as beds for the sick. These sacks to be provided in the same manner as 
clothing for the troops, and finally issued by the regimental clothier to the captain of 
each company, who shall be answerable for the same. 

WTien a soldier dies or is dismissed from the hospital, the straw he lay on is to be 
burnt, and the bedding well washed and aired, before another is permitted to use it. 

The sergeants and corporals shall every morning at roll-call give a return of the sick 
of their respective squads to the first sergeant, who must make out one for the company, 
and lose no time in delivering it to the surgeon, who will immediately visit them, and 



Eighteenth Century 159 

order such as he thinks proper to the regimental hospital; such whose cases require their 
being sent to the general hospital, he is to report immediately to the surgeon general, or 
principal surgeon attending the army. 

Once every week (and oftener when required) the surgeon will deliver the command- 
ing officer of the regiment a return of the sick of the regiment, with their disorders, dis- 
tinguishing those in the regimental hospital from those out of it. 

When a soldier is sent to the hospital the non-commissioned officer of his squad shall 
deliver up his arms and accoutrements to the commanding officer of the company, that 
they may be deposited in the regimental arm-chest. 

When a soldier has been sick he must not be put on duty till he has recovered sufficient 
strength, of which the surgeon should be judge. 

The surgeons are to remain with their regiment as well on a march as in camp, that 
in case of sudden accidents they may be at hand to apply the proper remedies. 



In 1778 the earliest American pharmacopoeia was prepared for the use of the Con- 
tinental Army by Dr. William Brown, Physician General of the Middle Department, and 
published anonymously (second edition, 1781). In 1776 Dr. John Jones published a 
treatise on wounds and fractures, which was not only tlie first American book on surgery, 
but also, through the appendix on camp and military hospitals, our first book on military 
medicine. In 1777 Benjamin Rush published his pamphlet on the hygiene of troops. 
Shippen drafted a plan for flying ambulances in 1777, and James Tilton introduced log 
hut hospitals in 1780. During the war the troops suffered much from sickness and cold, 
particularly in 1775, when a specimen sick report of September 23 records 2,817 out of 
19,365 (145.4 per 1,000), and in the severe winters of 1777-8 (Valley Forge) and 1779-80. 
The British troops suffered throughout the war from sickness and lack of supplies. Their 
regimental hospitals are described by Gore as "simple collections of sick men huddled 
together," without organization, regulations, clothing or rudimentary comforts. 

Variolation or preventive inoculation of human virus against smallpox was introduced 
in England by Lady Mary Wortley Montagu (1718-21) and in America by Zabdiel Boyl- 
ston (1721). Through the improvements in technic introduced by Kirkpatrick and Gatti 
(attenuation of the virus and dietetic preparation of the patient) this mode of preventive 
inoculation attained an almost scientific status, and the custom of "buying the smallpox" 
(purchase of scabs in open market) became common. The difficulty was that the 
inoculated person became a true smallpox carrier, while fatal mixed infections were 
numerous. In the Continental Army inoculation became common among the soldiers 
during the smallpox epidemic following the retreat from Quebec (1776), although for- 
bidden in General Orders, and use of unattenuated virus produced many fatal infections. 
The practice continued until swept away by Jennerian vaccination in 1796-8. 

After Yorktown (October 19, 1781) Congress rapidly demobilized the Army in 1782-3 
and the Hospital Department was practically disbanded. After June 2, 1784 the army 
consisted of 25 privates at Fort Pitt and 55 at West Point, "with appropriate officers." 
In 1788 there were 595 militiamen in the United States and 700, with 5 medical officers, in 
1789. By the act of March 5, 1792 the army was reorganized as a "Legion" (5,120 men) 
with Richard Allison as "Surgeon to the Legion" (1792-6). On May 3, 1798, war being 
imminent with France, Congress authorized an army of 10,000 men with James Craik 
as Physician General (1798-1800). These forces were disbanded in May-June, ISOO. 
The army was again increased for the war of 1812, and with the appointment of James 
Tilton as Physician and Surgeon General on June 11, 1818 the history of our permanent 
Medical Corps begins. 



CHAPTER VIII 

The Nineteenth Century 

Goethe relates that when he heard of the Diamond Necklace affair 
(1786) he surprised his friends by his strange abstracted demeanor, 
realizing, as he did, that the end of the old order of things was at hand.' 
Nearly half a century later the same Goethe was bored and indifferent 
over the July Revolution of 1830, and professed interest only in the 
contemporary disputes of Cuvier and St. Hilaire, which, in his view, 
reaffirmed the ancient unity of French science. Enthusiasm for the 
protagonist of the new order led Beethoven to inscribe the MS. of his 
Eroica Symphony "Napoleon Bonaparte" (1804). When Napoleon 
assumed the imperial throne in the same year, the great composer 
angrily tore off this dedication and dashed it to the ground.^ Under 
such auspices, the nineteenth century was born, and these anecdotes 
are symbolic of its political and social history. The "wild first year 
of the change of things" (1793) ushered in a new world; Napoleon's 
whiff of grape-shot before St. Roch (October 5, 1795) established the 
modern industrial democracy (la carriere ouverte aux talens), and with 
the battle of Waterloo (1815), England regained the ascendancy which 
had been hers in the early 17th century. The years between 1793 and 
Waterloo mark the height of French attainment in war and in the 
introduction of new ideas. In spite of the constant bloodshed, the spirit 
of the age of the "rights of man" was, for the Western Europeans, one 
of intense enthusiasm,^ keyed up to a pitch that thrilled even the passive 
Wordsworth — 

"Bliss was it in that dawn to be alive, 
But to be young was very heaven." 

In variety and extent of achievement this century surpassed the Ren- 



J Goethe: Annalen oder Tag-und Jahreshefte, 1789. Cotta ed., p. 11. The upshot of this affair 
was the sensational trial of May 31, 1786, in which the weak-minded Louis XVI threw the question 
of his wife's honesty into a public court, thus contravening the absolutist doctrine of the divine right 
of kings. 

' The printed title-page reads: per festeggiare il sovvenire d'un grande uomo. A striking feature 
of the enthusiasm of the Napoleonic period is the development of military music of a high order, e. g., 
Beethoven's Egmont and Coriolanus overtures, the funeral march in the Eroica, the alia lurca in 
his "Ruins of Athens," Schubert's "Marche Militaire," the stirring Rakoczy of the Hungarian 
soldalesca, etc. The jingling of spurs is hetu-d even in such late salon music as the mazurkas of 
Chopin, whose Marche funebre is usually played at military funerals. 

' " La Revolution commenca par Tenthousiasme des belles ames de toutea les classes. " Stendhal: 
Napoleon, Paris, 1898, 16. 
160 



Nineteenth Century 161 

aissance period; in poets consecrated to the cause of liberty, in philos- 
ophers, scientists and thinkers of the first order, in pubHcists and phil- 
anthropists who sought to create in the actual world the kingdom not 
made with hands, in the long line of French painters from Delacroix to 
Renoir, and of German composers from Beethoven to Wagner and 
Brahms. 

In science the laws of Conservation and Dissipation of Energy, which govern all 
physical and chemical phenomena, were elucidated by Carnot, Mayer, Joule, Clausius, 
Kelvin, Helmholtz and Gibbs. Darwin, Huxley and Haeckel created the realistic view 
of man's origin, evolution and environment. Bichat founded descriptive anatomy in 
1800. The cell-theory was developed by Schleiden and Schwann (1838-9) and was the 
starting point of the sciences of microscopic histology and pathology. Magendie gave 
a new start to experimental physiology, and Virchow to pathology. Pasteur founded 
bacteriology, while Koch developed the science of infectious diseases and Ehrlich serology 
and chemotherapy. L<>om the data of bacteriology, preventive medicine came to be a 
science. Clinical medicine of the true Hippocratic type was exemplified in such great 
names as Bretonneau, Louis, Laennec, Trousseau, Bright, Addison, Hodgkin, Graves and 
Stokes. Laennec invented the stethoscope (1819). Skoda and the French clinicians 
vastly improved the art of percussion and auscultation, and in establishing clinical ther- 
mometry (1868), Wunderlich "found fever a disease and left it a symptom." With the 
invention of such new instruments as the ophthalmoscope (Helmholtz, 1850) and the 
laryngoscope (Garcia, 1855), the different specialties began to acquire a scientific status. 
The history of modern surgery is a long story, turning mainly upon the introduction of 
anaesthesia (1847) and of antisepsis (Lister, 1867). Operative gynaecology was created 
by McDowell, Sims and other surgeons of the Southern States. German medicine 
began to gain its ascendancy with Virchow and Helmholtz (1850). The development of 
immunology and serology by Pasteur, Roux, Behring, Ehrlich and others, opened out 
a new view of disease — the biochemical. 

The Revolutionary and Napoleonic Wars 

In the battles which the "New French" of the Republic fought for 
its existence during 1792-1800, the general principles of modern war- 
fare, its merits and defects, were developed with startling suddenness, 
viz., gigantic armies, with a "nation in arms" as an apparently inex- 
haustible reservoir of personnel; organization of these huge forces into 
brigades, divisions and army corps; the device la patrie en danger as the 
motor power; "living on the country" with possibilities of loot, as an 
expedient to secure rapidity of movement (without encumbrance of 
commissary wagons) ; and unsparing use of field artillerj^ as the best 
means of destroying the equilibrium and morale of the enemy's lines. 

In the initial "cannonade of Valmy" (179'2) and the subsequent victories of Jemappes 
(179-2), Wattignies (1792), Tourcoiug (179-1) and Fleurus (179-1), these "horde tactics," 
frequently exploited over the roughest ground, proved an unpleasant surprise to the 
allied armies, bred in the 18th century doctrine of small, well-drilled forces, attacking 
and retreating by set rules, fighting over open terrain in linear formation, and depending 
upon supply-wagons. Aithougii desertions were raie in the Republican Armies, voluntary 



162 History of Military Medicine 

enlistments began to decrease as soon as the first flush of enthusiasm was over. After 
Vahny, the paper strength of 800,000 was found to be 402,000 (112,000 regulars), and it 
was through a compulsory levie en -nasse, under the terrorism of the Committee of Public 
Safety, that a million men were eventually raised. Generals who failed to make good 
were promptly guillotined; for officers and men alike it was safer to be in the army than 
in Paris under the Terror. Apart from the absentee imigres, this condition brought into 
the field the best of the physically fit as well as hundreds of defectives. France was 

saved by "a ferocious energy born of liberty and the guillotine not by discipline 

and organization" (Atkinson). Organization with a fair amount of discipline came, 
however, through the energies and abilities of Lazare Carnot, the great Republican 
general and Minister of War, and later through Napoleon, whose genius for assembling 
forces and ordnance, acting upon swift decisions, concentrating focal attacks upon definite 
points and inspiring morale in his men by personal contact, created a new era in warfare. 
A typical army corps of the Napoleonic period — three divisions of infantry and a cavalry 
brigade, each strongly supported by field artillery — is practically our organization of 
recent date.^ 

The medical personnel raised for these huge armies* was large, but of unequal merit, 
poorly trained by reason of the dissolution and non-existence of the French medical 
faculties during 1792-1803, and badly hampered by the arbitrary and irresponsible rulings 
of the National Convention, in consequence of which the medical corps of the French 
army was for a long time kept in leading strings by subordination, notto military authority, 
but to civilian administration. During 1792-3, as we have seen, the number of medical 
officers for the Revolutionary Armies was increased from 1,400 (the first voluntary enlist- 
ment) to 8,000, reaching 10,000 in 1794, largely through the law of the Convention 
(August 1, 1793) placing all physicians, surgeons, health officers and pharmacists of 18-40 
years of age at the disposal of the Ministry of War. On August 7, 1793 the National 
Convention started out well -with a decree of 7 paragraphs,* establishing the autonomy 
of the medical corps by assigning its administration to a Conseil de santi central, made up 
of medical officers in the War Ministry (ordinary War Department administration), 
apportioning the number of medical officers {officiers de sante) in armies or military 
hospitals, authorizing medical instruction in the military hospitals at Lille, Metz, Strass- 
burg and Toulon, and assimilating medical officers to corresponding grades of the line 
with reference to rations, forage, quarters, etc. In plain practical simplicity and inten- 
tion this decree compares favorably with the 42 articles of the hospital regulations of 
1718, the finest medico-military document of the 18th century.^ But hardly had the decree 
of August 7 gone into effect (September 1), when the fall of Robespierre established^a 
new alignment resulting in the pernicious law of 3 veutose II (February 24, 1794),' 
through which the central Conseil de sante was displaced by a CommissioJi de sante, under 
direction of a provisional "Executive Council," while military hospital administration 
was allocated to a "Supervising Administrative Committee," consisting of two municipal 
functionaries, two members of the Committee of Safety of the locality and the temporary 
commandant. To these latter, the chief medical officers, the war commissary and the 
directors were to report when so ordered. Still more ominous was the Ministerial Regula- 
tion of 30 floreal IV (May 20, 1796),' by which the authority for establishment of army 



'Atkinson: Encyclop. Britannica, xi ed., Cambridge, 1910, ii, 601; 619. 

•G. Morache: Diet encyclop. d. so. med. (Dechambre), Paris, 1877, 2 a., viii, 92-105. 

'For text, see Morache: op. cil., 94-96. 

' For text, see, Morache: op. cit., 81-!j3. 

' Morache: op. cit., 96-7. 

•Morache, 98-101. 



Nineteenth Century 163 

hospitals, mobilization and disposition of ambulances at the front and transportation of 
the wounded was taken from the chief surgeons and given to a Commissionaire ordon- 
nateur, to whom all medical officers were subordinated, while chiefs of medical service 
in hospital were forbidden to have anything to do with its administration. The effect 
of this arrangement was to demoralize the medical service and to drive all worthwhile 
medical officers away from the military hospitals into the field. "From the line of the 
army in the field," says Morache, "the medical officers met with just consideration and 
equitable appreciation of their services." When they sought to elude hospital service 
in wartime, they got vigorous support from their colonels, who, while complying with 
the arrangement in peace, defeated it in war by passive resistance to orders detaching 
surgeons from their commands for hospital service in the interior.^" The bright side of 
the French medical officer's experience in the Napoleonic period is therefore to be found 
in the field, and what he was able to accomplish was due to his military' rather than his 
official superiors. 

In the history of military medicine, Napoleon is to be regarded as a 
commander who accorded to favorites like Larrey or Percy every oppor- 
tunity to forward medical administration, according to their lights; but 
who was too much preoccupied with his innumerable ambitions and 
plans to give it more than passing attention. Of a leading Corsican 
family, "born when his country was dying," bred in the backwoods 
cult of the vendetta, endowed with "more than Italian passion," a patriot 
in Ajaccio, an arriviste in Paris," his ultimate mastery of his emotions 
gave him that cold marble repose in the saddle, that contempt for 
human life, which he was eventually to merge into a dry fatalistic dis- 
regard for the husbanding and salvage of personnel, the prime requisite 
in warfare on a grand scale. The reckless wastage of forces by the 
Revolutionary Armies had, in fact, inured him to the belief that he 
himself "cared little for the lives of millions of men." His conversa- 
tions with Corvisart reveal the same contempt for medicine that we 
find in Frederick. But he was by training a soldier himself, had a lively 
fellow feeling with comrades in arms and was by no means lacking in a 
certain grandeur d'dme toward his medical officers and wounded men. 



'" Morache: op. cil., 102. 

" It is a mistake to regard Napoleon as a parvenu in origin. The opening sentence of his letter 
to Paoli (" I was born when my country was dying") is the cry of the disinherited of 1789. The family 
was an ancient one, if we may trust Mauro, a 16th century chronicler: " Bonapartia gens, el nobilis el 
antiqua, ante annum 1200 inter nobiles semper fuisse reperilur." He was rather the opportunist, who 
hypnotized individuals and polarized nations, but made himself, in the end. as Emerson says, the 
attorney of the great pushing middle class, of whom every arriviste sought to be '"a little Napoleon." 
In his final phase, his relation to a possible victory became " that of the politician to the baby he kisses." 
Such bromides as 'that passage in Josephus about Jesus" (loudly repeated in the great Paris library) 
or " It fail cliaad" (repealed twenty times at a reception) were obviously gallery-play ^''defensive 
reactions") if contrasted with the point and pungency of his aphorisms about war and government. 
His early training was arid and narrow, and in society and in the presence of women, he was dry and 
uninteresting. Stendhal's chapter "La cour," tells, with characteristic malice, of his total failure to 
create, as "emperor," what the Parisians expected of him — an elegant social order. After Tilsit, even 
his bonhomie with comrades degenerated into the " secheresse" of which his officers bore the brunt at 
Waterloo. (Varnhagen, Stendhal, Capt. Gronow). 



164 History of Military Medicine 

Of hospitalization of the sick we hear but little, for military hygiene in 
the modern sense was non-existent, and the sanitary status of hospitals 
was almost the lowest in recorded history. Napoleon's campaigns, 
the favorite argument of the pacificists, present an appalling mortality 
from disease. Time and again he visited the wounded in hospital, 
listened to the reports of Larrey, Percy and Heurteloup after each battle, 
always inquired if the ambulances were provided with necessaries, but 
was given to making florid promises which he sometimes forgot or was 
unable to keep. Seeing the pitiful condition of the wounded at Erfurt, 
he said, "I donate 6,000 francs daily to the hospitals out of my private 
funds," and galloped away, apparently oblivious to the fact that this 
allotment could not be disbursed (as the sequel proved) without a 
written order. At Berlin in 1806 he convened all his medical chiefs to 
the palace and promised to make them an independent Corps imperial, 
but this, too, came to nothing. The recommendation to the Ministry 
for a better organization, signed by Coste, Heurteloup, Larrey, Desge- 
nettes and Percy in 1810, was laid on the table.^^ Yet in Egypt 
Bonaparte gave up all his horses to the ambulance service,, dismounting 
himself and marching on foot with the infantry.'^ At Eylau Baron 
Percy said that he could have obtained from him his very clothing for 
bandaging if necessary. The terrible break-down in hospitalization 
during the epidemics of 1813 has been attributed to the extreme parsi- 
mony of the General Intendant, M. Daru, toward the Medical Corps. 
The vice of the Napoleonic system (as with the Prussian General Staff 
in the recent war) lay in the mistaken belief that a nation in arms is 
an inexhaustible reservoir of personnel. 

After the splendid victories of 179-1-6, the direct result of Carnot's fine administration, 
scarcity of personnel began already to be felt. Conscription, following the Jourdan law of 
1798, came to be regarded as a sentence to life service, and by 1806, one-fourth of Napo- 
leon's conscripts failed to come up for dutj'. The fine flower of his veterans, the back- 
bone of the Grand Army, were gradually eliminated through battle-losses. In 1810 
the number of absentees was 80 per cent. Meanwhile, in consequence of the law of 1798, 
40,000 picked veterans were constantly employed in hunting down slackers, so that, in 
the end, about 100,000 men were engaged in a kind of civil war within French territory. 
In 1810 one-third of the Grand Army (now a dynastic concern) was German in composi- 
tion. In 1812 280,000 of the 467,000 men who started on the Russian campaign were 
unwilling foreigners," who rapidly deserted on opportunity,^* leaving the rest an easy prey 



" Morache: op. cit., 103. 

" This was the subject of a painting by Horace Vernet, reproduced in Cabanes: Chirurgiens et 
bless6s, Paris, 1918, 401. 

14 Atkinson: op. cil., 602, 619. 

" " Un colonel de mes amis me racontait, en allant en Russie, que depuis trois ans i7 avait tu passer 
trenle-six mille hommes dans son regiment. Chaque ann6e il y avait moins d'instruction, moins de 
discipline, moins de patience, moins d'exactitude dans I'obSissance." Stendhal: Napoleon, 49. 



Nineteenth Century 165 

to the allied forces at Leipzig (1813), now animated by the same fiery patriotism which 
had inspired the French in the Wars of the Revolution. 

Larrey 
The most eminent medical officer of the Napoleonic period was un- 
questionably Dominique-Jean Larrey (1766-1842), Chief Surgeon of 
the Grande Armee and the inventor of "flying ambulances." Originally 
a choir-boy in the Pyrenees, he studied medicine, and first served in the 
Navy, but later joined the Army of the Rhine in 1792. He met Napo- 
leon at Toulon (1794), served in all his campaigns, and the two became 
fast friends. Napoleon did not like desk-oflBcers and would promote none 
who had not served with troops under fire^^ or who had not been wounded 
in action. Larrej' was thrice wounded and so won the esteem as well 
as the affection of his chief, of whom Stendhal records that to see him 
ride along the line after a battle, encourage deserving and wounded 
officers and promote them, was one of the big moments of existence. ^^ 

Larrey took part in no less than 60 battles and 400 engagements, and indeed devoted 
his whole career to military surgery and to the welfare of the wounded soldier. His 
life was saved by Bliicher at Waterloo. He was a bold and enterprising operator with 
an extraordinary number of successful cases to his credit, became professor at the School 
of Military Medicine at Val de Grace (founded 1796), and wherever he happened to be 
he set up a school of military surgery. In Egyp the was the first to point out the con- 
tagious nature of granular conjunctivitis (1802), improved wound excision (debridement 
-prerentif), invented curved needles, used Labarraque's antiseptic solution to wash putrid 
wounds, and made other important innovations in all branches of military surgery. 
Early in the Revolutionary wars he noticed that, in consequence of the old 18th century 
rule of relieving the wounded only after a battle, transportation to base hospitals occupied 
£4-36 hours, due to stalling of vehicles on the roads. Larrey reasoned that it was better 
administration to take the hospital to the wounded, whence arose the celebrated ambulances 
tolantes (1792). ^^ These were of two kinds, viz., light closed two-wheelers carrying two 
wounded men each, drawn by two horses, for rapid movement over even ground, and 
heavier four-wheelers carrying four men, drawn by four horses, for rough, precipitous 



'• "Non, Messieurs! jamais je ne consentirai a avancer un ofEcier qui n'est pas alle au feu pendant 
dix ans." Stendhal: Napoleon, 45. 

" "A r armee, apres un victoire on apres un simple avantage remportS psu' une division. TEmpereur 
passait toujours une revue; Apres avoir passe dans les rangs, accompagne du colonel et parle a tous 
ses soldats qui s'fitaient distingues, il faisait battre au ban et les ofBciers se r^unissaient autour de lui. 
Si un chef de bataUlon avail ete tue, il demandait tout haut quel 6tait le plus brave capitaine. Lh, 
dans la chaleur de I'enthousiasme pour la victoire, et pour le grand homme, les avis ^taient sinctres, 
les reponses 6taient loyales. Si le brave capitaine n'avait pas de moyens pour etre chef de bataillon, 
illui donnait son avancement dans la Legion d' Ilonneur, et revenant k sa (juestion demandait: 
'.\pres un tel, quel est le plus brave.^' Le prince de Neufchatel tenait note des promotions avec son 
crayon. Dans ces moments, j' ai vu des soldats pleurer de tendresse pour le grand homme." Stend- 
hal: Napoleon, Paris, 1898, 46. 

".Ambulance service during battle became possible through the predominance of the artillery 
arm over the old-fashioned voUey-firing of musketry in platoon formation. The early Revolutionary 
Armies, after disastrous experience with linear formation in close order, began presently to choose 
rough ground, to tight in open order over the widest possible front, and at the same time to leave the 
early issue to field artillery and skirmishers, holding the majority behind the front lines for the final 
charge. 



166 History of Military Medicine 

ground. These wagons were fitted with removable litters (provided with mattresses and 
rolling on castors). Both varieties had holes for ventilation and carried refreshments and 
bandaging material. Hundreds of these wagons were eventually in action,^' beginning 
operations directly battle was joined, but it is said they were seldom employed outside 
the Guard. In the army of the North Percy originated another kind of wagon carrying 
8 surgeons, 8 hospital attendants and bandaging material, but these were not designed 
for evacuation. To Percy is due the organization of squads of litter-bearers (brancardiers) , 
who were first employed in the Spanish campaigns (1808), and were then added by Larrey 
to the ambulances volanies. In Egypt Larrey employed camel transportation with swing- 
ing side-panniers (cacolets), and sent his wounded from Alexandria to Marseilles in hospital 
ships. But in spite of the big humanitarian spirit of Larrey the sick and wounded were 
frequently abandoned through lack of transport on Napoleon's forced marches and 
retreats, or else as Duncan says, " were stuffed in buildings of every sort and left to die."^" 
Of the Peninsular campaigns General Foy recounts that "we lost four times as many 
men through the disorder inseparable from our system of warfare as from the fire and 
steel of the enemy. "*^ An anonymous publication of 1814 abounds in gruesome details 
of the misery of the sick and wounded in the hospitals of 1813, which the writer styles 
"the sepulchres of the Grand Army."^ Of the small amount of good which came out of 
the innumerable edicts and regulations of the National Convention Morache observes, 
with a touch of sadness: " Malheur eusement il y a toujours en France un grand ecart entre 
ce qui est prescrit et ce qui s'execute reellement."'^ But we shall presently see that these 
discrepancies between plan and performance are by no means confined to France. 

The Peninsular Campaign'^* 
The part played by England in the Revolutionary Wars was mainly 
at sea. Nelson's great victory off Cape Trafalgar (October 21, 1803) 
at length convinced Napoleon that he had no chance on the water. 

In the Egyptian campaign sickness began to increase after the battle of the Nile, the 
troops suffering mainly from granular conjunctivitis, dysentery and liver complaints. 
The total death rate was 109 per thousand for European and 60 per thousand for rative 
troops; the losses from invaliding 41 and 6 per thousand respectively. In April, 1809 
39,'214 men were conveyed to the island of Walcheren in 245 transports, with one hospital 
ship, an e.xpedition directed against Napoleon's naval base at Antwerp. By August 15 
3,000 men were down with fever. By September 14 8,000 were reported sick and on 
October ii only 4,000 were fit for duty. The total mortality was 217 from battle casual- 
ties and 4,175 from disease, the expedition proving the failure that Napoleon had predicted 
("fever will finish them"). Some sLxty \-ears before, Pringle had gone over this ground 
and described its diseases, with an inkling of what might happen. In April 1809 Sir 



" The Divition d 'ambulances proposed by Larrey for the Rhine campaign consisted of 1 surgeon 
first class, 2 surgeons second class, 12 surgeons third class, 12 hospital attendants {infirmiers) , all 
mounted, 44 hospital attendants on foot, and the line officers and non-commissioned cfijcers attached 
to the trains. The train consisted of 12 light ambulances (8 two-wheelcrs, 4 four-wheelers.) and 4 
heavy ditto, outfitted with materiel and refreshments, and accommodating 2-4 wounded. The heavy 
ambulances were ordinary transport wagons (fourgons) . Officers and privates alike carried pouches ot 
bandaging materiel, and were distinguished from the rest of the command by a special scarf. Knorr: 
op. eit., 207-208. 

=» L. C. Duncan: Disease and Battle Casualties. Seaman Prize Essay, p. 22. 

2' Foy: Histoire de la guerre de la Peuinsule, Paris, 1827, i, 145. Cited by IMorache, 103. 

-2 Les sepulcres de la Grande Vrmee. ou tableau des hopitaux pendant la dcruiore campagne de 
Bonaparte. Paris. Eymery, 1313, Cited by Gurlt. 

" .Morache: op. cit., 99. 

•* A. A. Gore: The Story of Our Services under the Crown. London, 1879, 153-160. 



Nineteenth Century 167 

Arthur Wellesley arrived in Portugal, with Dr. Frank as chief medical officer of his forces. 
Before the end of the year there were some 7,000 sick, of whom nearly 4,000 died. During 
the Peninsular War the average sick-rate was 210 per 1,000, the principal diseases being 
fevers, dysentery, rheumatism and respiratory affections, with hospital gangrene and 
tetanus among the wounded. The soil was damp, and prior to the siege of San Sebastian 
(1813) there were no tents, the men living in huts of wattled boughs. There was much 
malingering; as many as 600 bayonets were sent back to duty in a month by clearing the 
hospitals of shirkers. Large general hospitals were established at Lisbon and Coimbra 
for the reception of sick who could not be transported. The annual loss during 1811 
was 20,553, including 12,356 deaths. The death-rate during 1808-14 was 118 per 1,000, 
the total losses 24,930 out of 61,511 from disease and 8,889 from battle casualties. Lord 
Wellington's administrative arrangements were good and he was well inclined to the 
medical service, in which he was ably supported by Sir James McGrigor (1771-1858)," 
who joined his forces in 1812 and at whose instance medical officers were first gazetted 
in despatches for bravery in action after the assault on Badajoz (1812). During Sep- 
tember 1812 — June 1813 some 93,348 sick and wounded were admitted to hospital. 
McGrigor, who had seen the finale of the fatal Walcheren expedition, reduced this sick list 
to 5,000, was generously rewarded and praised at the end of the war, and became Director 
General of the Medical Department (1816-51). In 1816 he founded the famous patho- 
logical museum and library at Fort Pitt (later Netley) and inaugurated the system of 
medical reports and statistical army returns of the present Blue Book (1816). Much was 
done to reform sanitary administration by Robert Jackson (1750-1827)-^ of Scotland, 
whose books and writings of 1798-1824 lay down basic principles which might have been 
better enforced in his lifetime but for his pugnacious disposition. He was an early cham- 
pion for suitable military rank, emolument and honors for British medical officers, but, 
to the detriment of his cause, was a man of strife and contention. He reasoned that 
"handling a knife is the least part of a regimental surgeon's duty" and that "the medical 
officer claims to himself the rank of gentleman."^' He estimated that 2 medical officers 
per 1,000 .'ere needed in peace and 3 per 1,000 in war, and urged the employment of 
sanitary personnel ("health officers") in the army. The Royal Warrant of January 1, 
1806, stopping 10s. per diem for the hospital fund, was due to Jackson's demonstration 
that the sum which fed a soldier in barracks sufficed (at that time) to provide him with 
food and comforts in hospital. 

The War of Liberation 
Like most military supermen who become infected with the fatal 
virus of world conquest. Napoleon eventually overreached himself and 



2» For his career, see Gore; op. cit., 149-158 passim. 

"For Jackson's career, see Gore: op. cil., 119-124, and Crumnier: Mil. Surgeon, Wash., 1922 
L, 107-122. 

""Rank of gentleman": This is a phase of the naive romanticism of the Georgian- Victorian era 
which so endears the 19th century to us. The "rank" implied is that of independent landed gentry. 
It will be remembered that the Prussian field-barber had to shave the officers and was cudgelled by his 
superiors if refractory. An eminent English surgeon said of that rough diamond John Hunter: "He 
alone made us gentlemen." Lady Cheltam in "Middlemarch" refers to her family physician as 
having the social qualifications of her butcher. In the more realistic 20th century, it was perceived 
that the medical officer, if shorn of proper military authority (as was the younger Larrey at Solferino'*; 
can do nothing for relief of the sick and wounded in campaign; otherwise, he made his ow n social posi- 
tion, as did Pare or Vesalius in the past. Under democracy the constant "I'm a gentleman" in the 
mouths of bounders and ruffians became so farcical that the cheerful cynicism of a wealthy "baronet" 
in an English melodrama — "My wife is not a lady and I am only a shopkeeper" — was greeted by the 
audience with spontaneous and enthusiastic applause. 



168 History of Military Medicine 

did nothing well after the battle of Wagram (1809). He had been 
worsted by England on the seas, his wasteful campaign across the 
PjTcnees made Spain "the Frenchman's graveyard, "^^ his second 
marriage was a political blunder of the first order, and the disastrous 
Russian invasion of 1812 sealed his fate. He had said with prophetic 
insight, " Conquest has made me what I am and conquest must maintain 
me. " It had long been perceived by the nations gathered to finish him 
that his mighty empire was held together solely by his unique person- 
ality and military- genius. The first steps toward Waterloo were taken 
by \Yellington in the Peninsula and by the Prussians in the "War of 
Liberation." 

After the annihilation of the Prussians at Jena (1806) the restrictions 
of the treaty cutting down the army to 43,000 men were evaded by the 
so called Krumper system, through which the men in the ranks were 
put on short service and secretly replaced as rapidly as possible, thus 
building up an endless chain of reserves which, in Scharnhorst's phrase, 
amounted virtually to "universal service." It is upon this newer eco- 
nomics that the modern theory of universal training of reserves is 
based. 

Goercke 

During the Revolutionary Wars the Prussian medical service had 
become ossified and out of date. The new spirit infused into it was due 
to Johannes Goercke^^ (1750-1822), surgeon general during 1797-1822. 

At this time, the status of medicine in Germany was backward, and apart from few 
names like Heim, Huf eland or Reil, there is little to its credit. Goercke devoted two years 
to the close study of medicine in all the leading centers of Europe, and after his discouraging 
experiences in the Revolutionary Wars (1792-5), the Pepiniere for better instruction of 
medical officers was founded at Berlin, at his instance, on August 2, 1795. In 1801 he 
induced the king to establish a definite system of pensions for invalided medical officers 
and in the same year required personal reports on the efficiency of company surgeons to 
be sent in by battalion and regimental surgeons. Through his efiForts the military hos- 
pitals prepared for the reception of the wounded from Eylau (1807) were found to be 
models of cleanliness and good ventilation. He served through all the campaigns of the 
period and was so much admired by Baron Percy that the latter induced Napoleon to 
make a handsome contribution to the Pepiniere in 1805.'° This institution, which became 
the Friedrich Wilhelms Institut in 1818, graduated 1,359 medical officers during 1795- 
1821. In the Rhine campaign (1793) Goercke obtained funds for a movable field hospital 
for 1,000 patients, which rendered effective service, but there were none during 1806-9. 
The direction of the field hospital service was eventually assigned to Goercke (August 8, 
1809), who drafted the new hospital regulations of October 2, 1809. In August, 1813 



2' The ghastly features of the Peninsular Wars, including the various devices of "frightfulness" 
(rape and mutilation of the defenceless) have been preserved by the Spanish artist Goya in his album 
of etchings "Los Desastres de la Guerra." 

" For biography of Goercke, see, Bock & Hasenknopf : Ver6ffentl. a. d. Geb. d. Mil.-San.-Wesens, 
Berl., 1901, Heft 18. 219-260. 

'" For Goercke's own account of this, see Bock & Hasenknopf: op. cit., 247. 



Nineteenth Century 169 

the army had 3 general hospitals of 1,200 beds each, 1 reserve hospital of 3,000 beds and 
9 field hospitals of :200 beds each — a total of 8,400 beds. There were 38 (eventiially 124) 
"provincial (reserve) hospitals" in the towns, and of those the elder Graefe was director 
during 1813-15. Wooden barracks, introduced into Austria in 1788, appeared in Prussia 
in 1805-6, and a number of barrack hospitals were erected in 1813-15. Voluntary nursing 
was in vogue from 1800 on and received a powerful impetus under the patronage of 
Princess Marianne of Prussia (March 23, 1813). Transportation of the wounded was 
effected by water during the Rhine campaign of 1792-5. Transport wagons were intro- 
duced by Goercke in 1795, but only 3 were available in 1813. Litters and litter-bearers 
were not known in Prussia before Goercke's publication of 1814.'^ In 1822, disheartened 
by the constant attempts to undo his Pepiniere, Goercke sent in his resignation to the 
king after 55 j^ears service, and died six weeks later (June 30, 1822). His successors were 
J. W. von Wiebei (1822), C. F. Lohmeyer (1847), H. G. Grimm (1851). G. A. von Lauer 
(1879), Alwin von Coler (1889) and Otto von Schjeming (1905-18) .^^ 

Battle Losses in the Napoleonic Wars ^^ 

Of the 4J^ million soldiers engaged in the Revolutionary and Napoleonic Armies during 
1792-1815 about 2}/2 million died in hospital and 150,000 were killed in action. FroHch 
computes the total losses of the French and the Allies in the Xapoleonic campaigns 
(1801-15) to be, in round numbers, 5,925,084. In the Egyptian campaign (1798-1800) 
Bonaparte lost 4,758 out of 30,000 in action and 4,157 from disease, of whom 1,689, 
including 40 medical officers, died from bubonic plague. On the Russian campaign (1812) 
his total forces, increased to 533,000 by reenforcements, had shrunken to 95,000 when he 
reached Moscow, although there had been only two battles, while the Russians lost about 
170,000 out of 210,000. The campaign of 1813-14 cost both sides 450,000 and that of 
Waterloo 60,000. Between July, 1813 and March, 1814 there were 133,965 sick and 
wounded in the Prussian military hospitals, and of these 15,748 died, 84,805 were dis- 
charged cured, 3,177 were invalided, and 394 unaccounted, leaving on hand in March, 
1814 29,841 (6,422 sick, 23,149 wounded). Durmg June-August. 1815 42,092 sick and 
wounded were treated in 60 military hospitals between Memel and Evreux, of whom 948 
died, 29,165 recovered, 626 were invalided, and 60 unaccounted, leaving 11,293 on hand 
on September 1. 

The losses in the principal battles from Austerlitz to Waterloo were: 

Austerlitz (December 2, 1805): French, 12,000 killed and wounded out of 94,000; 
Austrians and Russians, 26,000-30,000 out of 84,000. 

Jena-Auerstadt (October 14, 1806): French, 6,000 out of 96,000; Prussians, 12,000 
out of 54,000. 

Eylau (February 8, 1807): French, 15,000 out of 79,000; Allies, 18,000 out of 74,000. 

Friedland (June 14, 1807): French, 12,100 out of 86,000; Russians, 10,000 out of 
46,000. 

Aspern (May 21-23, 1809): French, 8,000 killed, 24,000 wounded out of 70,000; 
Austrians, 4,287 killed, 16,213 wounded out of 80,000. 

Wagram (July 6, 1809): French, 23,000 killed and wounded. 7,000 missing out of 181,- 
700; Austrians, 19,110 killed and wounded, 6,740 missing out of 128,600. 



" Goercke: Kurze Besclirelbung der bei der k. preiLssischen Annee stattfindenden Krankentransport- 
mittel, Berlin, 1814. For full account of the hospitals, transport, voluntary nursing, etc., see, Bock 
& Hasenknopf: op. cit., 156-200. 

^ P. Myrdacz: Das deutsche MilitAr-Sanitatswesen, Wien, 1896, 28. 

"C. Richter: Allgemeine Chirurgie der Schussverletzungen im Kriege, Breslau, 1877, 898-940. 
Frolich: Ztschr. f. KrankenpQ., Berl., 1896, xviii, 89-90. Bock & Hasenknopf: op. cit. (Veroffentl. 
(etc.), 1918, rviii, 196). 



170 History of Military Medicine 

Smolensk (August 17,1812): French,20,000out of 180,000; Russians, (?) out of 130,000. 

Borodino (September 9, 1812): French, 32,000 out of 130,000; Russians, 42,000 out 
of 121,000. 

Gross-Gorschen (May 2, 1813): French, 6,000 kiUed, 11,000 wounded out of 90,000; 
Allies, 10,000 killed and wounded out of 54,000. 

Bautzen (May 20-21, 1813): French, 5,000 killed, 14,000 wounded out of 150,000; 
Prussians and Russians, ',500 killed, 16,000 wounded out of 110,000. 

Leipzig (October 16-19, 1813): French, 30,000 out of 145,000; Allies, 60,231 out of 
300,000. 

Quatre Bras (June 16, 1815): French, 4,300 out of 22,000; Allies, 5,600 out of 33,000. 

Ligny (June 18, 1815): French, 8,500 out of 71,000; Prussians, 12,000 out of 84,000. 

Waterloo*" (June 18, 1815): French, 30,000 killed and wounded, 6,000 prisoners out of 
72,000; Allies, 21,997 (1,120 officers) out of 120,000. (British 15,000; Prussians 6,000— 
7.000). 

The Mexican War ^^ 

The Mexican War (1846-48) is highly instructive to Americans as a campaign of small 
dimensions, entered upon caravan-wise with boyish, meridional enthusiasm, waged in 
an unknown country without forethought or adequate preparation, by an army equipped 
on a peace footing, and carried to a successful issue in spite of untold sufiFering from lack 
of clothing, supplies, rolling stock and adequate medical administration. At this time 
the Regular Army numbered 7,500 and the Medical Department consisted of a Surgeon 
General with the rank of colonel, and 71 medical officers, increased by Congressional 
acts of 1846-7 to 115, with 135 surgeons for volunteer forces (total 250). About 100,000 
men were sent to Mexico during 1846-8, so that only 6 companies of regular troops were 
left in the whole United States (Duncan). The commanding general (Winfield Scott) 
was a veteran of tried ability, who stands high in the annals of his profession as an officer 
who consulted freely with his medical staff. He was accompanied by the Surgeon General 
(Thomas Lawson) in person. The motor power of this campaign was romantic enthu- 
siasm, rather than the "hostile feeling" or the "hostile view" of the military authorities. 
Under the "hostile view" an armed force (e. g., that of Dewey at Manila) is an impersonal 
agent of government, executing the will of government in wars imposed upon a nation 
by an impersonal "enemy," and it is the duty of the people to maintain such forces in 
adequate preparedness to insure against the humiliating consequences of defeat and 
major losses from battle casualties and disease. The lack of medical preparedness in the 
Mexican War was no worse than that in the Crimean or Solferino episodes, and was due to 
the lack of real knowledge of military sanitation at the time. There were no ambulances 
in the army before 1859. Only 180 mule-drawn wagons were available on April 5, 1847. 
There were no shelter or hospital tents, hospital equipment, cooking utensils or other 
conveniences, and marching for months in one uniform the soldiers were soon barefooted 
and in rags. Ignorance of the character of water-supplies brought hundreds down with 
diarrhoea and dysentery; hospitals were hastily improvised in any convenient buildings, 
and the misery of the sick was increased by the squalor of Latin surroundings. Con- 
ditions improved after the entry into the Mexican capital, when General Scott levied 
$20,000 "for the sick in hospital." Duncan gives the total losses as 1,549 killed and died 
of wounds, 10,951 died of disease, 13,825 discharged for disability. The heaviest casual- 
ties were at Cherubusco (1,074), Molino del Rey (779) and Chapultepec (801). The 
disease rate was 110 per 1,000 as compared with Qo in the Civil War and 16 in the World 



'^Called by the Prussians "Belle Alliance." 

"J. B. Porter: Am. J. M. Sc. Phila., 1852, n. s., xxiii, 13; xxiv, 13; 1853. xxv, 25; xxvi, 296; 1858, 
XXXV, 347. L. C. Duncan: Mil. Surgeon. Wash., 1920, xlvii, 436; 596; 1921, xlvii, 76. 



Nineteenth Century 171 

War. The sick-rate from dysentery was high and the disease was widely spread through 
the home country by the returning troops. Through the Mexican war the United States 
acquired Texas, New Mexico and California, for which $15,000,000 were paid by the 
government; while the army gained retirement for officers, military rank for medical 
officers and the Soldiers' Home at Washington. 

The Crimean War^^ 

Of all recorded wars the Crimean (1854—55) has perhaps the greatest 
teaching value for military medicine. For the Western allies it was 
fought in a circumscribed area far distant from the centers of authority 
and supplies. The English and French commanders soon found them- 
selves hampered by conflict with their home governments as to the 
conduct of the war, to the utter neglect of proper sanitary and supply 
service, a condition which well-nigh wrecked the whole enterprise 
through losses from communicable diseases. The establishment of 
telegraphic communication between France, England and the Crimea 
imposed a dreadful incubus upon those in actual contact with the 
enemy. London and Paris burned the wires with strange administra- 
tive orders which blighted the energies of able commanders and all 
but extinguished the medical service. Canrobert resigned to serve 
faithfully in a subordinate capacity. His successor, Felissier, was 
reduced to impotent fury and Lord Raglan died of worry. The medical 
officers of the French army were completely subordinated to the intend- 
ance or civil administration and had no authority beyond that of ordi- 
nary civilian practitioners at the bedside. In the British service the 
status of battalion and regimental surgeons was virtually the same, 
although the hospital and ambulance service was officered by the line, 
with no distant bureaucratic control. 

The war lasted from September 14, 1854 to July 12, 1856, and was mainly concentrated 
on the siege of Sebastopol, the sally-port of the Russian fleet. The assault on the Mala- 
koff and the capture of Sebastopol terminated a drawn contest which resulted in nothing, 
and which cost Great Britain 8335,340,000, France $451,980,000 and Russia $690,1^0,000. 
The total French forces in the Crimea numbered 309,268 men, of whom 500 were medical 
officers; the English, 97,804, with 448 medical officers; the Russians, 324,478 with 1,608 
army surgeons and 3,759 Feldshers; the Sardinian, 21,000, with 88 surgeons; the Turkish 
35,000 with no medical personnel whatever. Eerndt estimates the total losses from all 
causes as: Allies, 252,000; Russians, 256,000, and Mulhall gives even larger figures. 
Myrdacz estimates: 

French: 8,250 killed; 39,808 wounded; 4,354 died of wounds; 196,430 sick; 59,815 
died of sickness. 



" Great Britain: Medical and surgical history (etc.), 2 vols. London, 1858. Sir T. Longmore: 
The Sanitary Contrasts of the British and French Armies during the Crimean War. London. 1883. 
P. Myrdacz: Sanilals-Geschichte des Krimkrieges. \\'ien, i;(9o. F. H. Garrison: Mil. Surgeon, 
Wash., 1917, ili, 457-473. For the life of Pirogof f . see his ■'Lobeiisfragen" in Bibliothek russischer 
Denkwiirdij^kciton. Stuttgart. J. G. Cotta, 1894, an astonishing mixture of religous mysticism and sagacity. 



172 History of Military Medicine 

English: 2,755 killed; 18,283 wounded; 1,847 died of wounds; 144,390 sick; 17.225 
died of sickness. 

Russians: 21,000 killed; 92,381 wounded; 14,671 died of wounds; 332,097 sick; 37,454 
died of sickness. 

In other words the Russians had twice as many killed and wounded as the allies, 
while the ratio of battle casualties to deaths from disease was 1.4 among the allies, and 
1.1 among the Russians. Among the French the mortality from disease was 253.5 per 
1,000; that of the English 119.3, that of the Russians 161.3. The Crimean War shows 
the highest battle losses per thousand (among the Russians) and from disease (among the 
French) of all the wars in history. These latter were largely due to cholera, typhus fever 
dysentery and scurvy. Longmore's computations show that exclusive of cholera, the 
British losses from disease during 1854 were 2,373, the French 1,857, while in 1856 
the English lost only 218, the French 17,129, and for the following reasons: The British 
entered upon the war in a state of unpreparedness, with only 40 ambulance wagons, a 
pack-mule and 10 litters for each regiment, no winter clothing, no shelter tents and a 
worthless corps of male nurses, commandeered from the line; while the French had shelter 
tents, division ambulance companies (field hospitals of 18 tents), abundant supplies and 
materiel, and even fur overcoats. As time wore on the terrible losses among the British 
from disease created a great sensation in the press, with the result that Parliament and the 
public took hold of the situation and sent out clothing, supplies and transport in profusion. 
At the instance of Sidney Herbert Florence Nightingale went out with a corps of trained 
nurses and what she accomplished created modern nursing. The suffering troops were 
eventually housed in wooden huts with adequate creature comforts. Even the food-supply 
and cookery were in the hands of the famous chef, Alexis Soyer.'^ Meanwhile the French, 
still under canvas in the severe winters of 1855-6, were worn out with the prolonged exer- 
tion of warfare; their mortality and mortality statistics went up as the English went down. 
Thus the conclusion of the war was an object lesson in the evils resulting from lack of 
sanitary preparedness and in those resulting from gradual slackening of the eternal vigil- 
ance which is necessary to good sanitation. The Russians eventually secured a large corps 
of trained nurses under the direction of Nikolai Ivanovich Pirogoff (1810-81), a military 
surgeon of the first rank. In England the scandals incident to the War resulted in a 
prolonged investigation, the publication of the first medical and surgical history of a 
war by government (8 vols., London, 1855-8), and enlarged military authority for British 
medical officers. 

The lesson of the Crimean War is that a central civil administration will do little 
for the successful conduct of a campaign, if it neglects its primal duty of sending all neces- 
sary supplies, reinforcements and medical aid to the forces at the front, yet hampers their 
commanders and medical officers with orders and suggestions based upon academic assump- 
tions and insufficient knowledge of actual conditions at the theatre of war. 

The Italian Campaign of 1859^^ 

This war, waged for the liberation of Italy from the Austrian yoke, was fought by 
70.000 Sardinians under Victor Emanuel II, 128,000 French allies and 230,000 Austrians. 
In the actions at Montebello (May 20), Palestro (May 31), Melegnano (June 8), and the 
battles of Magenta (June 4) and Solferino (June 24), the Austrians mere defeated. The 
peace of Villafranca (July 11) ceded Lombardy to Piedmont while Venice was retained 
by Austria. The Austrian Army had ambulances, field hospitals and s;;nitary com- 



" For an account of Soyer's remarkable work, see the interesting article by Capt. J. S. Taylor, 
U. S. N., in U. S. Naval Med. Bull., Wash., 1921. xv, 13Q-17.3, port. 

"P. Myrdacz: Sanitats-Geschichte dcs Feldziiges 1859 in Italien. Wicn. 1B96 



XlXETEENTH CeXTUKV 173 

panics, but their medical administration in the field broke down through the fact that the 
chief surgeons of the two armies were mewed up in general headquarters and not allowed 
to have access to the field commanders, so that there was no centralized direction for 
relief of the wounded. In the French army the chief surgeon. Baron F. X. Larrey, jr., 
was under the thumb of the general intendant at Paris, the real executive, to whom Larrey 
could only submit "propositions," with the usual deplorable effects upon field medical 
administration. The correspondence between Paris and Larrey, published by Chenu, 
shows how sorely the chief surgeon's patience was tried by this short-coating. The 
natural sequels of this irritating decentralization came to a head on the bloody field of 
Solferino, where the debacle of relief of the wounded was complete and disgraceful. Out 
of all this came one great good. In 1862 Henri Dunant (1828-1910), an eye-witness of 
this battle, published " Un Souvenir dc Solferino," and his account of its horrors led to an 
International Conference of the Red Cross Societies at Geneva in 1863 and to the Geneva 
Convention of August 22, 1864, in virtue of which the fourteen signatories pledged their 
respective nations to regard the sick and wounded, as also the army medical and nursing 
staffs, as neutrals on th§ battle-field. This Convention was observed all over the world 
up to the European War. 

The Civil War^' 

Lynch has defined the period 1865-98 as "the day of small things in 
the United States Army." In the period 1800-61 there was but little 
advance made in medical administration over the methods used in the 
Revolution, when, as Hoff says, "all that our people knew of military 
affairs came from the British." The policy followed at the conclusion 
of each war was the then current English plan of cutting down the 
Army and Medical Corps to an irreducible minimum. During this 
period our small army was distributed in small commands, stationed 
at isolated and widely scattered posts, at which the business of the 
medical officer was confined to routine duties and practice at the post 
or among the civilian population. The effect was sometimes to pro- 
duce the enslaved or discontinuous mind, the habit of thinking in 
petty terms, of interpreting the letter rather than the spirit of Regula- 
tions. The Civil War found the government unprepared, with the 
necessity of beginning a gigantic contest with undisciplined, inexpe- 
rienced volunteers, and with many of the fine flower of the West Pointers 
gone over to the South, The earlier failures of the Union forces were 
obviously due to incompetent, dilatory generalship and to narrow 
adherence to worn-out routine in the central administration. In the 
eyes of foreign military authorities the Civil War has little teaching 
value, except as demonstrating that armies voluntarily enlisted for a 
war period, "while capable of unexcelled feats of endurance" are "in- 
capable of forcing a swift decision," an alternative which usually 



"United States, War Dcparlmrnt, Surgeon General's Office. Medical and Surgical History of li;e 
War of the Rebellion. 6 vols. Washington, 1870-88. L. C. Duncan: The Medical Department of the 
United States Army during the Civil War, Washington, 1914. 



174 History of Military Medicine 

proves an expensive luxury as far as the lives and financial resources 
of tax-payers are concerned.^" 

Letterman 

Given the size of the armies raised, the medical arrangements for 
evacuation and care of the wounded were meagre. There was no 
organized ambulance or field hospital service, no organization for 
evacuation to the interior where hospital service was hastily improvised 
in hotels, barns and neighboring private houses. The introduction of 
rifled arms, with fixed ammunition and conoidal bullets, had vastly 
increased the range and rapidity of fire, with much wider danger-zones 
and greater scattering of the wounded over the field. As the engage- 
ments increased in magnitude, the wounded lay helpless on the battle- 
fields for hours extending to days before the slow -work of evacuation 
was completed. Duncan relates that, on two occasions, evacuation to 
Washington was attempted by commandeering 100 rickety hacks and 
hucksters' wagons from that city.^^ The teamsters driving army wagons 
were drunken, insolent and insubordinate. There was no effective 
bridge in the way of sanitary formations operating between front and 
base to relieve commands overwhelmed with casualties. This not only 
caused immense suffering and losses among the wounded, but interfered 
with the mobility of fighting units through delays and stalling of 
vehicles, sometimes demoralized commands as to fighting capacity, 
and encouraged skulkers to desert the lines under pretext of assisting 
the wounded to the rear. All this was changed by the advent of Jona- 
than Letterman (1824-72), who succeeded Tripler as medical director 
of the Army of the Potomac on June 19, 18G2, and whose genius for 
medical administration brought about the epoch-making reforms which 
became a pattern for all subsequent armies and eventually fixed prin- 
ciples in our own.^^ In his capacity for thinking in large terms. Letter- 
man was very adequately encouraged by his military chiefs McClellan 
and Hammond, whose letter of June 19 commits to him "the health, 
the comfort and the lives of thousands of our fellow-soldiers." 

On August 2, 18C2 Letterman's plan for an Ambulance Corps was at once put into 
effect in the field by McClellan's General Orders of that date, further amplified in G. O. 
of August 24, approved by Hammond (September 7), adopted by Grant in the ^^'est 
(G. O. March 30, 1863) and, although disapproved by Halleck and Stanton, eventually 
incorporated by Congress in the Act of March 11, 1865. It provided for an ambulance 
corps for each army corps, with two-horse vehicles provided with 2 litters each, in the 
proportion of 3 for each regiment of 500. The corps was officered by a captain as com- 



*" Atkinson: op. cil., 603; 623. 
«i Duncan: op. cil., 31; 36-38; 43. 

"Letterman; Medical Recollections of the Army of the Potomac. New York, 1866. Medical 
and Surgical History of the War of the Rebellion. Surg. vol. pt. iii, Washington, 1883, 923-986. 



Nineteenth Century 175 

mandant, with 1 lieutenant for each division or brigade, 1 sergeant for each regiment, 2 
privates and 1 driver to each ambulance and 1 driver to each medicine wagon. The 
personnel, detailed from the line to secure well-disciplined men at the start, was under sole 
control of the medical director; provisions for drill of the corps, parking and disposition 
of the vehicles in the train were made, and use of the ambulances for any other purpose 
than evacuation was forbidden. Letterman's system was first tried out at the battle of 
Antietam (September 17, 1863), and here, as medical director of an army of 100,000, he 
was able to demonstrate its worth in the face of great difBculties in obtaining ambulances, 
equipment and supplies. At the first Bull Run one-half (550) of the 1,100 Union wounded 
had been sent to Richmond as prisoners, the rest reaching the lines at Arlington on foot 
or in vehicles as best they could. At Cedar Mountain some of the 1,445 wounded 
remained on the field for 36 hours, at Manassas the wounded remained on the field all 
night before evacuation. On the march to Antietam Letterman had collected supplies 
and some 300 ambulances four days before, and although the battle line was 6 miles 
long and the number of wounded 10,000, all had been collected and sheltered inside of 24 
hours. Soon after Antietam Letterman attacked the problem of supplies, which under 
the old regimental system of distribution, were either in excess of requirements or deficient, 
and in the former case, came to be recklessly wasted when their bulk made them impedi- 
menta on a march or in retreat. In his circular (with supply-table) of October, 4, 1862 
(revised September 3, 1863) Letterman changed all this by an economic selection of the 
amounts of different medicines and materiel to be transported, and thus reduced the num- 
ber of supply wagons b}^ nearly one-half. Under the old system there were stationary 
regimental (tent) hospitals and base hospitals improvised in large buildings in interior 
towns. Letterman's Circular of October 30, 186-2 introduced his third great improvement 
in medical administration, viz., mobile field hospitals, consisting of tents and equipment, 
manned by appropriate medical and surgical personnel, for receiving and treating the 
wounded evacuated from the lines prior to ultimate evacuation to base. With the aid 
of these hospitals and the ambulance companies the great gap between front and base 
was bridged, and it became possible to relieve and treat the wounded during battle. 
Letterman's ambulance organization continued to gain in efficiency in such major battles 
as Fredericksburg, Gettj'sburg .and Chickamauga, but his completed system was not in 
full swing until the beginning of Grant's and Sherman's campaigns of 18C4, in which 
it reached its height of perfection. The 200 ambulances constructed early in ISGl, 
before Letterman's detail, were light two-wheeled carts of the old Larrey type, which 
gave the wounded intolerable discomfort by their rocking motions and were soon dis- 
placed by capacious four-wheelers of varied type. The litters employed were of canvas 
stretched across two poles. Freight and passenger cars were converted into hospital 
cars with three stories of berths on either side. Steamboats and steamships were 
employed for water transportation. The base hospitals, both Union and Confederate, 
were at first located in adjacent hotels, churches, factories, warehouses, schools, academies 
and private dwellings, e. g., the National Hotel, Georgetown College and Odd Fellows 
Hall, D. C. (1861), or the Tishomingo Hotel (Corinth, Miss.). As the wounded poured in 
from the great battles, additional wards were constructed around these buildings as 
nuclei and finally separate groups of ridge-ventilated wooden pavillions were constructed, 
of one story each, arranged in geometric figures around a central administration building 
and connected by covered passageways, the originals of our base hospitals in tlie recent 
war. The first of these was the large wooden structure erected at Parkcrsburg, Va. (1862). 
Some of them, such as the Satterlee (West Philadelphia) or the Mower at Chestnut Hill, 
had over 3,000 bed capacity. ^^ In these advances in ambulance and supply service and 



♦^For the hospitals, see Med. & Sur^. Hist, (etc.) Med. vol. pt. iii, Wash., 1888, 896-966. 



176 History of Military Medicine 

hospitalization, much was due to the propagandism of the Sanitary Commission (organized 
June 9, 1861) and the Christian Commission. Although these organizations were inclined 
to magnify and overestimate their importance, they were undoubtedly the main sources 
of food, medicines, clothing and other much needed supplies during the early period of 
the war. A questionnaire for hospital inspectors had been devised by Tripler, but the 
Sanitary Commission was also instrumental in forwarding sanitary inspection of camps 
and hospitals. In 1864 the medical organization included divisional medical directors 
and medical inspectors, chief surgeons of divisions, brigades and division hospitals, divi- 
sional attending surgeons, regimental assistant surgeons, and commanders of divisional 
and brigade ambulance companies.** Acting assistant or contract surgeons were employed 
for special duties, and among the volunteer medical personnel many of these were detailed 
on part-time service, continuing practice in their home cities. Hammond's Circular of 
May 21, 1862 (No. 2 S. G. O.) ordered more exact and detailed reports of the sick and 
wounded and the diligent collection of pathological specimens, projectiles, etc., from the 
battlefields, resulting in the foundation of the Army Medical Museum (August 1, 1862) 
Hammond also projected an Army Medical School, but this was discouraged by Stanton. 
The Medical and Surgical History of the War, adumbrated in Hammond's circular of 
May 21, 1862 and edited up to 1884 by Joseph J. Woodward and Charles O. Otis, was 
completed after Woodward's death by Otis, Charles Smart and David L. Huntington, 
and published, in six massive volumes, during 1870-88. This work received at once the 
high commendation of Virchow and other European authorities and was undoubtedly 
the most important contribution to military medicine and surgery yet made. The 
medical statistics of the war were not published in the Surgeon General's Annual Reports 
during 18G1-2, but in the history of the war, which contains the records of the brilliant 
work done in the medical conduct of the war by Letterman, McParlin, Woodward, Otis 
Billings, Woodhull and others. 

Battle Losses in the Civil War 

The losses among the Union forces were 44,238 killed in battle, 49,731 died of wounds, 
186,216 died of disease, 24,184 died of unknown causes (total, 304,369). A later A. G. O. 
estimate gives 67,058 killed, 43,012 died of wounds, 224,58j6 diseases, and 24,942 unknown 
causes (total, 359,598). The Confederate losses were: Killed in action 94,000; died of 
disease 59,297; losses in prisoners and deserters 188,372 out of 781,192. For the killed, 
wounded and missing on both sides in all the battles and engagements from April 12, 
1861 to May 26, 1865 see Surgical Volume (Part I) of the Medical and Surgical History 
of the War (1870), pp. XXXIV— CXL. 

The losses in the principal battles were: 

Bull Run (July 21, 1861): Union, 481 killed, 1,011 wounded and 1,460 missing; Con- 
federate, 269 killed, 1,483 wounded. 

Seven days before Richmond (June 26th to July 1, 1862): Union, 1,582 killed, 7,709 
wounded and 5,958 missing; Confederate, 2,820 killed, 14,011 wounded and 752 missing. 

Cedar Mountain (Aug. 9, 1862): Union, 450 killed; 660 wounded, and 290 missing; 
Confederate, 229 killed, 1,047 wounded and 31 missing. 

Bull Run (2d) (Aug. 30, 1862): Union, 800 killed, 4,000 wounded and 3,000 missing; 
Confederate, 700 killed, 3,000 wounded. 

Antietam (Sept. 17, 1862): Union, 2,010 killed, 9,416 wounded and 1,043 missing; 
Confederate, 3,500 killed, 16,399 wounded and 6,000 missing. 



" For the duties of these officers in campaign, see, Med. i Surg. Hist, (etc.) Surg. Vol. pt. iii. Wash., 
1833,899-914. 



Nineteenth Century 177 

Fredericksburg (Dec. 13, 18G2): Union, 1,180 killed, 9,028 wounded and 2,145 missing; 
Confederate, 579 killed, 3,870 wounded and 127 missing. 

Chancellorsville (May 1-4, 1863): Union, 1,512 killed, 9,518 wounded and 5.000 miss- 
ing; Confederate, 1,581 killed, 8,700 wounded and 2,000 missing. 

Gettysburg (July 1-3, 18G3) : Union, 2,834 killed, 13,709 wounded and 6,643 missing; 
Confederate, 3,500 killed, 14,500 wounded and 13,621 missing. 

Wilderness (May 5-7. 1864) : Union, 3,288 killed, 9,278 wounded and 6,784 missing; 
Confederate, 2,000 killed, 6,000 wounded and 3,400 missing. 

Cold Harbor (June 1-12, 1864) : Union, 1,905 killed, 10,570 wounded and 2,456 missing. 
Confederate, 1,200 wounded and 500 missing. 

Kenesaw Mountain (June 9-30, 1864) : Union, 1,370 killed, 6,500 wounded and 800 
missing; Confederate, 110 killed and wounded, 3,500 missing. 

Petersburg (June 15-19, 1864): Union, 1,298 killed, 7,474 wounded and 1,814 missing. 

Atlanta (Hood's first sortie) (July 22, 1864): Union, 500 killed, 2,141 wounded and 
1,000 missing; Confederate, 2,482 killed, 4,000 wounded and 2,017 missing. 

The Seven Weeks War^^ 

In the Seven Weeks War (1866) the advantages of breech-loading over muzzle-loading 
weapons were demonstrated for the first time. The Austrian Army of the North, num- 
bering 328,168 men, was armed with old-fashioned muzzle-loading rifled artillery carrying 
the case-shot (shrapnel) of the Napoleonic wars. The Prussian army confronting them, 
numbering 302,134, was armed with breech-loading rifled cannon and with breech-loading 
eedle guns sighted to 400 yards. But although the Austrians were esteemed superior- 
nto their adversaries, their troops had to load standing up, which gave their opponents a dis 
tinct advantage, while the Prussians were superior in physique, training and general 
staff work. The Austrians were easily picked off by the long range rifles of the enemy, 
who could now creep up inside the artillery range and fire lying down, thus nullifying the 
effect of case-shot. In the battles of June 26-July 22 the Austrians lost 10,070 killed, 
29,675 wounded, 13,330 missing; the Prussians 3,439 killed, 12,491 wounded, 702 missing. 
Cholera, typhus fever and dysentery were very prevalent at this time and were spread 
through Prussia, Saxony, Bohemia and Moravia by the invading army. The Prussians 
had 64,191 sick, of whom 5,219 died, 39,258 were discharged and 19,714 remained in hos- 
pital. This condition occasioned a sharp critique of the Prussian sanitary administration 
by army surgeon, G. F. F. Loeffler, the historian of the war (1868).^* Loeffler pointed 
out that the mortality of 103^2 per cent among the wounded in the different battles and 
of 113^ per cent at Koniggratz, as also the sick lists, while an improvement on the past, 
were a measure of sanitary inefficiency. Meanwhile, in consequence of these conditions, 
the king called a conference of the leading military surgeons of Prussia, which lasted from 
March 18 to May 5, 1867 and resulted in a complete reorganization of the medical service 
of the Prussian Army, including the expansion of voluntary first aid in accordance with 
the Geneva Convention of August 22, 1864. 

The Franco-Prussian War'^'' 

In this war, the most remarkable example in recent times of a cam- 
paign adroitly motivated, suddenly precipitated and brought to a 

" p. Myrdacz: Sanitats-Geschichte der Feldzuge 1864 und 1866. Wien, 1897. F. H. Garrison: 
Mil. Surgeon, Wash., 1917, xli, 711-717. 

** F. Loeffler: Das preussische Militar-Sanitatswesen and seine Reform nach der Kriegeserfahrung 
von 1866. Berlin, 1868. 

*' P. Myrdacz & J. Sleiner: Sanitats-Geschichte des deutsch-franzosischen Krieges 1870-71 
Wien, 1896. 



178 History of Military Medicine 

speedy conclusion by "short, sharp and decisive" action, the Prussians 
profited by the lessons learned in 1866. They entered upon the cam- 
paign fully prepared, mobilized their entire forces in 8 days (July 16-24, 
1870) and concluded the war in five months on January 28, 1871. 
There is no question that the French labored under the disadvantages 
of inferior leadership, poor training, faulty equipment, and the cumber- 
some methods of their bureaucracy. 

During the war the French forces were increased from 244,828 to 534,000 (total 
mobilization 800,000), the German from 384,000 to a mean strength of 788,213 (total 
mobilization 1,113,700). The French medical organization was that of 1854-9; the total 
number of medical officers being 1,020 or 127 less than required in the cadre. The direc- 
tors of administration in the field were the m6decin inspccteur (for the whole army) and 
a midecin principal for each army corps. Each army corps and each division had its own 
ambulance service manned by 4-5 physicians and 20 nurses, with wagons and animals, 
but no litter-bearers. Evacuation of the wounded was assigned usually to troops detailed 
from the line. First aid stations were manned by the battalion physician and bandagers 
behind the firing lines. Division ambulances were posted 4 km. beyond, corps ambulances 
further back, transportation being effected with the ambulances on hand and by other 
vehicles available. The Prussians had a much larger medical personnel, viz., 3,853 
medical ofl5cers, eventually raised to 5,548 from civil life, 5,858 hospital attendants, 2,921 
nurses, 468 apothecaries. 

The medical administration in the Prussian \Yar Department was directed by the 
Surgeon General (H. G. Grimm). The cadre of the field formations included a chief 
surgeon for each army, corps surgeons for the separate corps, division surgeons, regimental 
surgeons, battalion surgeons, with chief staff surgeons, staff surgeons and assistant sur- 
geons for the cavalry and artillery. Each mobile army corps had a surgical consultant, 
3 sanitary detachments manned by 2 staff surgeons, 5 assistant surgeons and 124 litter 
bearers, and 12 field hospitals (officered by a staff surgeon and 3 assistant surgeons). 
The Saxon, Bavarian, Wiirttemberg and Baden army corps had similar cadres. The 
lessons taught by Larrey and Letterman had been well learned. The mobile sanitary 
formations of these armies were as follows: 

North German Confederation: 43 sanitary detachments, 170 field hospitals, 45 sec- 
tions reserve hospital personnel, 16 hospital reserve depots. 

Bavaria: 4 sanitary companies, 12 receiving field hospitals, 4 main field hospitals. 

Wiirttemberg: 4 field sanitary trains, 6 field hospitals, 1 hospital reserve depot. 

Baden: 1 sanitary detachment, 5 field hospitals, 2 sections reserve hospital personnel, 
1 hospital reserve depot. 

Evacuation of the wounded was managed as follows: the officers led the litter bearer 
companies into the battle lines in two detachments consisting each of 5 patrols, and 3 
litters each manned by 4 bearers (2 alternates for long distance evacuation). The wounded 
were collected, given first aid and refreshments where possible, and rapidly conveyed to 
the ambulances assembled at nearby stations, which carried them to the main dressing- 
station, whence they were taken to the field hospitals by ambulances belonging to other 
detachments or any available vehicles. When the ambulances near the firing lines were 
in motion to and fro, the litter-bearers conveyed the wounded directly to the main dressing 
station, whence the slightly wounded proceeded on foot to the field hospitals. The severely 
wounded were then sent to evacuation hospitals (Efappenlazareitc), and thence to the 
base or barrack hospitals which usually had to be built, as only 162 tents were available 
in the Prussian Army. The large general hospitals in the cities were sometimes quadrangu- 



Nineteenth Century 179 

lar and sometimes V-shaped (as at Hamburg [Altona] and Mannheim) or M-shaped (as 
on the Tempelhof in Berlin), with the administration and other buildings in a perpendicu- 
lar line let fall from the central angle. There was a large organization for voluntary nurs- 
ing in the cities, patronized by the elite. The French arrangements for evacuation in the 
field followed the modern lines, but were deficient in personnel and materiel, while there 
had been no preparation for hospitalization in the interior. Assistance to the wounded in 
the cities was eked out by charity of the public spirited and by voluntary nursing organiza- 
tions. There were also volunteer sanitary formations in the field, such as the Anglo- 
American Ambulance organized by the American gynaecologist, Marion Sims. The 
German hospitals in the zone of advance handled 468,487 sick and 92,164 wounded and 
of these about 250,000 were evacuated to the interior. Chenu computes that the French 
had 131,000 wounded and 339,421 sick (total 609,961), of whom there were 136,540 killed, 
missing and died from wounds and disease. The Germans had 1 16,826 killed and wounded 
out of 738,213 mean strength (148.2 per 1,000) and of these 17, 255 were killed and 11,023 
died of wounds. Some 475,000 sick were admitted to hospital, of whom 14,004 even- 
tually died. This was, therefore, the first war of magnitude in which the mortality from 
battle casualties (among the Germans) exceeded that from disease. The most fatal com- 
municable diseases were typhus and typhoid fevers, smallpox, and dysentery. This 
campaign afforded a scientific proof of the value of Jennerian vaccination. Among the 
German troops, who had been vaccinated and revaccinated, the smallpo.x incidence was 
4,835 cases, with 278 deaths; among the French prisoners, only part of whom had been 
vaccinated, it was 14,178 cases, with 1,983 deaths. An elaborate official history of the 
Prussian Army medical department in the war was published in 1884-90.''* 

The losses in the different battles were:*" 

Worth (August 6, 1870) : French, 17,000 killed, wounded and missing out of 50,000; 
Germans, 10,643 out of 120,000. 

Spicheren (August 16): French, 3,976; Germans, 4,872. 

Colombey (Borny) (August 4): French, 3,608 out of 84,000; Germans, 4,907 out of 
57,000. 

Vionville (Mars la Tour) (August 16): French, 17.231 out of 113,000; Germans, 
15,800 out of 63,000. 

Gravelotte (August 18) : French, 12,275 out of 140,000; Germans, 20,173 out of 188,000. 

Beaumont (August 30): French 4,800; Germans, 5,534. 

Sedan (September 1): French, 14,000 out of 120,000; Germans, 8,931 out of 220,000. 

Noisseville (September 1): French, 3,542; Germans, 2,978. 

The Russo-Turkish War (1877-78)50 

This war (1877-78) is of interest as establishing the value of intrenchments and field 
works in securing invisibility against artillery fire. The spade was freely used on both 
sides as the Turks were armed with Krupp breech-loaders (artillery). Martini rifles (infan- 
try) and Winchester carbines (cavalry). The Turks were better armed and proved to be 
better fighters, but they had no such generals as Skobelefif and Todleben, and their com- 
manders were overriden by their politicians at Constantinople "with the disasters which 
invariably follow the attempt of civilian amateurs to control warlike operations" (Crowe). 
The only decisive battles were the Russian defeats at Plevna (1877), with Russian losses 



*' Germany: Kriegsminisieriam, SanitAts-Bericht uber die deutschen Ileere im Kriege gegen Fraok- 
reich 1870-71. 7 vol. in 11 pU. Berlin. 1884-90. 
«• Myrdacz: op. cit., passim. 
"i P. Myrdacz: Sanitats-Geschichte des russisch-tUrkischen Krieges 1877-78. Wien, 189 



180 History of Military ]\Iedicixe 

of 2,898 and 7,338 on July 20 and 30, the fall of Plevna and the Turkish rout at Philip- 
popolis (1878). In the Turkish army of 363,000 men there was no organization for 
evacuation of the wounded, who were taken out of the lines by comrades. The Russians 
had an organized medical corps, ambulances and litter-bearers, "temporary war (field) 
hospitals," troop and division hospitals, retreats for the light sick and slightly wounded 
(okolotki) and large general hospitals in the cities of the interior helped out by the volun- 
tary nursing organization of the Russian Red Cross; but their losses from typhus, dysentery 
and battle casualties were heavy, viz: 

Army of the Danube (592,085 men): 11,905 killed, 43,386 wounded, 4,955 died of 
wounds; admissions to hospital, 951,993; died of disease, 50,464; deaths from typhus and 
typhoid, 23,752 out of 135,239 cases; deaths from dysentery, 9,543 out of 43,386 cases. 

Army of the Caucasus (mean strength 246,454) : 13,206 wounded; 1,809 died of wounds; 
admissions to hospital, 1,198,023; died of disease, 34,877; deaths from typhus and typhoid, 
20,233 out of 01,298 cases; deaths from dysentery, 3,552 out of 22,984 cases. 

unitary Surgery in the 19th Century'"^ 

The wars of the 19th century drew into the military service some of the greatest 
surgeons of the period. Larrey, Percy, Hennen, Guthrie, Dieffenbach, the elder Langen- 
beck and the elder Graefe served in the Napoleonic Wars, of which Larrey 's "Memoires 
de medecine militaire" (1812-17) is the most enduring surgical memorial. Sir Charles 
Bell attended the wounded after Corunna and Waterloo; Dupuytren those from the July 
Revolution of 1830. John Hennen's surgical treatise of 1818 is a valuable surgical record 
of the Napoleonic period. Blandin rendered service in Algeria, Velpeau and Jobert de 
Lamballe looked after the casualties of the February Revolution of 1848. Esmarch and 
Stromeyer served in the campaigns of 1849-51, 18G4-6 and 1870. The great name of 
Pirogoff is associated with the Crimean and Russo-Turkish Wars. W. W. Keen, Weir 
Mitchell, Morehouse, J. M. DaCosta, Otis, Billings and Hunter McGuire were prominent 
in the Civil War. Bilroth, Langenbeck, jr., Volkmann, Esmarch, Gurlt, von Bergmann, 
Bardeleben, Wilms, Czerny, Nussbaum, and the elder LoefHer served in the Franco-Prus- 
sian War. 

The military surgery of the century underwent profound changes in consequence 
of the introduction of ether and chloroform anaesthesia (1847), surgical antisepsis (1867) 
and the many improvements in weapons and missiles. The great discovery of Rontgen 
(1895) was already to prove its worth in the Spanish-American War (1898-9). Ether was 
immediately taken up by Pirogoff and Syme (1847) and in the same year it was also 
employed in the Mexican War. The supreme advantage conferred upon the military 
surgeon by anaesthesia was not merely in the banishment of pain, the disconcerting cries 
and struggles of the patient, but in the complete abolition of slap-dash operating. Under 
the older conditions the patient had to be held by several persons, fortified by stimulants 
and moral encouragement, or even stupefied by opiates to the limit of tolerance, as in the 
case of Astley Cooper's attempt to tie the subclavian (1809)." Brilliant surgeons like 
Fergusson, Pirogoff or the elder Langenbeck became sleight-of-hand operators, whisking 
off a limb before the patient realized it. With the aid of anaesthesia the operator in the 



51 For the history of modern military surgery, see E. Richter: Allgemeine Chirurgie der Schuss- 
verletzungen im Kriege, Breslau, 1877 (with admirable sections on the history of military medicine in 
fine print). Also, Bock & Ilasenknopf; VerofTentl. a. d. Geb. d. Alil.-San.— Wesens, Berl., Heft 18, 
1901. 45-155: Heft 21, 1904, 1-178: Heft 27, 1904, 43-385. 

"Described by Valentine Motl in: Med. Repository, N. Y., 1809-10, xiii, 331-334. It is highly 
probable that opiates were administered before 1847 in more major operations than we know of. The 
advantages in ligations of the larger arteries or in any operation in which a slip of the surgeon's hand 
might end the struggling patient's life, are self-evident. 



Nineteenth Centurv 181 

6eld could proceed with the same careful, deliberate precision as in his own clinic, and in 
consequence almost any regional surgery could now be attempted, except in the danger 
ous hollow cavities. But on the battlefield and in hospital sepsis, wound infection, 
gangrene, tetanus and erj^sipelas still proved the bane of surgery and occasioned a dreadful 
mortality in wartime. The discoveries of Pasteur and Lister (1867) created the newer 
surgery. At the outbreak of the Franco-Prussian War the military applications of 
antisepsis were set forth by Lister himself in his paper of 1870,^ and the end of the war 
(1871) saw his method firmly established in the field by Volkmann, Mikulicz, Thiersch 
and others. Lister's tour through Germany in 1875 was in the nature of a triumphal 
progress. The introduction of steam sterilization of instruments (1886) and of general 
asepsis (1891) by Ernst von Bergmann added the copingstone to the edifice. The stetho- 
scope (1819), the hypodermic sjTinge, of which various types had been invented by F. 
Rynd (1845), C. G. Pravaz (1851) and A. Wood (1855), and the clinical thermometer, 
although known, were regarded as clinical curiosities and did not become a part of general 
hospital and military practice until about 1866-70. Billings was one of the few medical 
officers who had a hypodermic kit in the Civil War. It was during the last three decades 
of the 19th century in fact, that medical and surgical practice began to acquire something 
of a scientific status. After 1885 small firearms began to diminish in weight, length and 
caliber of barrel, magazine or rapid fire guns were substituted for the single loader, and in 
consequence smokeless powder came into use to prevent fouling of the barrel from rapidly 
repeated discharges. To adapt soft leaden bullets to the rifling in rapid firing at high 
velocity, it became necessary to jacket the leaden core with some smoother, harder metal, 
while at the same time, to attain a high velocity and to overcome resistance, the pro- 
jectile was decreased in caliber and weight and increased in length. Weapons were pro- 
duced which could deliver 40 shots a minute at a range of 4,000 yards with missiles of 
extraordinary penetrating power, while improvements in sighting made for uncanny 
marksmanship. Thus a new kind of warfare was introduced ivith projectiles which, at 
long range, either killed outright or, if not attaining a vital spot, produced a small, clean- 
cut wound with little shock and greater chance of recovery. The old, larger calibre bullet, 
with larger wounds and greater shock, was more effective in stopping charges at a certain 
range. In cases of fracture of the long bones the small calibre bullet is capable of pro- 
ducing terrible laceration of the soft parts and extensive splintering, simple perforations 
of flat bones or empty hollow viscera, and the usual explosive effects in the brain or the 
filled stomach. All this led to experimental studies of wounds by small-calibre projectiles, 
the relatively benign nature of which had been pointed out by Verneuil in 1867. But 
in 1902 La Garde demonstrated that pathogenic organisms in powder or on bullets are 
not destroyed by the heat of firing, so that, as the European War proved, we can no longer 
rely upon the theory of sterile gunshot wounds. They are not "poisoned" as those before 
Pare thought, but usually infected. Until the days of trench-warfare operative surgery 
on the front line was virtually banished from the battlefield. The changes rung upon 
treatment of gunshot wounds and fractures in the light of studies of the newer projectiles, 
the newer orthopedics from Delpech and Stromeyer to Thomas, Sayre and Hoffa, the 
military surgery of the nervous system, the chest, the viscera, the genito-urinary system, 
constitute a field too vast for exposition here. Wound-incision known to Pare was con- 
verted by Larrey into wound excision {debridement preventif), as we now know it. After 
his time it fell into abeyance until the European War. The revival of routine and some- 
times reckless amputation necessitated the invention of many new varieties of orthopedic 
appliances and artificial limbs. 



" Lister: Brit. Med. Jour., London, 1070, ii, 243. 



182 History of ^Military Medicine 

Military Sanitation in the 19th Century 
Of medicine Napoleon said contemptuously "Water, air and cleanli- 
ness are the chief articles in my pharmacopoeia." This rule-of-thumb 
hygiene, based upon folk-intuition and cult-cleanliness, was all that 
could be had before the time of Pasteur and Koch. The Romans drained 
swamps without knowing why, and the spirit that informed Charles 
White's midwifery treatise of 1773 could not make obstetric procedure 
aseptic except, perhaps, in his own practice. To go beyond the excellent 
rules of military hj^giene laid down by Pringle (1752) and Brocklesby 
(1764), something more was needed, something not to be found in the 
excellent treatise of E. A. Parkes (1864) written at the instance of 
Sidney Herbert, nor in Pettenkofer's experimental data upon air, water, 
the soil, etc., upon which such treatises were usually based. The new 
stimulus came from the data of bacteriology which, as Fiexner said, 
"transformed hygiene from an empirical art into an experimental 
science." In the middle period, prior to the foundation of Koch's 
Institute for Infectious Diseases (1891) in Berlin, some clever things 
were done. John Snow, who checked the spread of water-borne cholera 
in London by taking off the handle of the Broad Street pump (1854), and 
William Budd, who stopped the rinderpest of 1866 "with a poleaxe and 
a pit of quicklime, " both kne.v how to prevent epidemics, and William 
Farr had already evolved curves from which their course might be pre- 
dicted (1840-66); but the real change came with the application of 
Koch's ideas in stopping water-borne cholera at Hamburg by proper 
filtration (1892-3). This was the starting point of the newer preventive 
medicine, in which to ascertain the mode of transmission of a disease is 
more important than to discover its cause, and in which we no longer 
wait for the disease to occur but attack its transmitting agents before- 
hand. This did not become apparent until long after Manson's dis- 
covery of the mosquito as a vector of Filaria (1879) and Laveran's 
discovery of the parasite of malarial fever (1880). It was the demon- 
stration of the malarial parasite in the mosquito by Sir Ronald Ross 
(1897-8) which established the theory of insect-borne diseases in prac- 
tical sanitation. The brilliant results in mosquito-control obtained by 
Ross in Africa (1899-1902) and by Gorgas in Havana (1901) and 
Panama (1904-13) made this method a fixed procedure in military 
hygiene. The discovery of immune human carriers in t^'phoidal and 
other infections revolutionized the whole science of disease prevention. 
The carrier, the contact and the suspect now became more dangerous to 
the community than the disease itself, and it was perceived that there 
can be no real prophylaxis in venereal diseases without control of the 



Nineteenth Century 183 

male as well as the female carrier. Meanwhile, in consequence of the 
scientific development of food chemistry, metabolism, heating, ventila- 
tion and disinfection, the enlisted man's ration, housing and hospitaliza- 
tion came to be studied from a more enlightened point of view. The 
exhibits of 19th century uniforms at the Dresden Hygienic Exposition 
(1911) showed how long the soldier continued to be made miserable by 
the heavy shakos, helmets, tight collars and burdensome equipment and 
weapons of the past. 

Prostitution and Venereal Diseases^* 
It was from the data of bacteriology and parasitology that the 
sanitarian began to get his first glimmerings of the real social significance 
of venereal infections as opposed to the older theological concept, 
but he was not destined to see the venereal carrier as he saw the carriers 
of phthisis, dysentery or influenza until the time of Schaudinn, Wasser- 
mann and Ehrlich (1905-10). Meanwhile the management of venery 
and venereal infection in armies continued along conventional lines, 
with the new device of virtual conscription of prostitutes by police 
control. The Roman and German plan of forestalling infection from 
promiscuity' by domesticating soldiers' wives in regiments (the analogue 
of the safe and secret societies for intersexual relations which existed 
among the aristocracy before the Revolution) broke down under the 
newer doctrines of the political equality of all men and women before 
the law, and the dignity of industrialism. A Prussian Regulation of 
August 8, 1835 directs all civil and militarj' physicians to report infected 
prostitutes to police headquarters for purposes of control. A Cabinet 
Order of 1844 ordered all brothels in Berlin to be closed by January 1, 
1846, but the only result was to multiply novel methods of clandestine 
prostitution among the civil population, so that the number of syphilitics 
in 1846-7 was greater than in 1844-5. The brothels were reopened 
in 1851 under police control, to be closed again in 1856. The only new 
feature in subsequent regulations was "restriction of relations of the 
military with the civilian population" (order of January 27, 1907). 
In France events took about the same course. Napoleon patronized 
"control" in his usual superficial way, e. g., in his "magnificent gesture" 
to Bernadotte: "Je vons felicite siir rot re reglement snr les femnies. 
C'est nn ahits a proscrire." In the Regulations of the port of Brest 
(1830) soldiers were ordered to report all known infected women. 
A Belgian order of 1842 even authorized punishment of soldiers with- 
holding the names of such women. Closure of brothels in garrison 
towns was sometimes circumvented bv the threats of commanding 



'Haberling; Ztschr. f. Bekimpf. d. Gesohlechtskr., L-^ipz., 1915, XV, 332-358. 



184 History of Military Medicine 

officers to have their troops removed. The miUtary portion of Parent- 
Duchatelet's great report on prostitution in the city of Paris (3d edition 
1857)** is the only close analysis of causes and effects and should be 
read by all medical officers on account of its freedom from cant, its 
statement of things as they are, and its robust common sense. During 
the Civil War medical (as differentiated from police) control was 
introduced with such entire success at Nashville and Memphis that, 
as Surgeon Robert Fletcher reported,*® the women became "earnest 
advocates of a system which protects their health and delivers them from 
the extortions of quacks and charlatans." In England the Con- 
tagious Diseases Act of June 11, 1866 required every public prostitute 
at a naval or military station to be examined in a dispensary, and if 
infected, to be placed in a government hospital for treatment. This 
Act, obviously fair and scientific in intention, was shown to have had a 
remarkable effect in lowering the rates of venereal infection during the 
17 years of its operation, since, in the military scheme of things, it 
became possible to control both male and female carriers; but due to 
the peculiar bias of Anglo-Saxon sentiment it was abolished in the 
House of Commons on motion of Mr. Stansfeld, on April 21, 1883. 
Thereafter the only course open to the military authorities was the 
hypocrisy of apparent compliance with public opinion set off by occa- 
sional recourse to such measures as had undoubtedly been employed 
before the passage of the Act and had led to its formulation. Mean- 
while Darwinism and other phases of biological doctrine had tended 
to strip away the garments of pious make-believe from many aspects 
of the nature of man, particularly normal sexuality; while at the same 
time a prominent effect of this novel reasoning was to break down the 
restrictions upon which social morality is based and the religious 
sanction which had given it emotional force in the past. Since morality 
is only an inhibition at best, it came to be regarded as admirable that 
people should "struggle" for their existence, and he who did not display 
strenuosity in attempting to outdo and belittle his neighbor was rated 
as a weakling. Police control of prostitution (the worst possible kind 
of control) came to be exploited by the corrupt politicians of cities as 
a means of graft, and in Eastern Europe unfortunate and poverty- 
stricken women were bullied into prostitution by the police or shipped 
as merchandise to distant ports. There arose the monstrous doctrine 
that human beings can be bettered from without rather than from within. 
For the brutalizing effects of this "struggle-for-Iife" theory of existence 
civilized humanity was to pay a terrible penally in {.he episode of the 



'^ Pareat-Duchatelet: De la prostitution dan^ la ville de Paris. 3. ed. Paris, 1857, I, 541. 
" Med. .': Surs. History of the War. Med. Vol. Pt. Ill, Wash., 1S88, 891-398. 



XiNETEENTH CeNTURV 185 

European War, which brought to a striking focus the problem of sexuahty 
and venereal control. 

The Spanish-American War^'' 

The Spanish-American War (1898) was fought mainly upon the sea, 
and the total battle-casualties were slight, viz., in the Navy 1 officer, 
17 men killed; in the Army 22 officers, 244 men killed, 275 died from 
wounds or accidents out of a mean average strength of 235,631. Some 
3,450 died of disease due mainly to an epidemic of typhoid fever among 
the troops at the camps at Chickamauga and Montauk Point. The 
military forces in Cuba, Porto Rico and the Philippines accomphshed 
what they set out to do in good time and without difficulty, but the 
severe incidence of malarial and yellow fevers among the troops in 
Cuba necessitated withdrawal of the army from that island once the 
main object of the expedition had been accomplished, and the volunteer 
medical personnel in the American camps was not equal to the task of 
coping with the typhoid epidemic. This break-down in medical adminis- 
tration was due in part to the meagre equipment and personnel allotted 
the army on a peace footing, and to the fact that the war was entered 
upon, after the usual fashion of Anglo-Saxon nations, without previous 
planning or forethought. The findings of the Dodge Commission 
appointed by the President to investigate the conduct of the war resulted 
in certain important changes in the organization of the Medical Depart- 
ment, to which Surgeon General Robert M. O'Reilly (1845-1912) 
devoted his administration (1902-9), and which were to prove the main 
factors of success in our medical arrangements for the pan-European 
War. To understand the significance of these it is necessary to go back 
a little. 

In the earlier period William Beaumont (1785-1853) performed, in the back-woods of 
Michigan, those epoch-making experiments on gastric digestion and on dietetic scales 
(1824-33) which made him the founder of physiology in our country. But in these early 
days our diminutive army was mainly occupied in nursing along and developing the 
frontier civilization of the great West, that almost unknown phase of its service to 
which Sir Richard Burton paid sympathetic tribute^' and which McCaw has eloquently 
described :*' 

"Our small regular army has never received from our people the credit due for its 
long and patient work in helping to build up the civilization of the great West. The 
army has never been a band of idlers, fattening upon the Treasury and waiting for wars 
that never came. There has never been a time that the army wcs net actually doing 
something for the people. The fringe of the civilization of the West grew steadily forward 
under the shadow of line upon line of little military stations. The plains and hills, where 



" G. M. Sternberg: Jour. Am. Med. Ass., 1898, xxxi, 1356-1360. Also: .^.nn. Rep. Surg. Gen. 
U. S. Army for 1898 and 1899. 

" Sir R. Burton: The City of the Saints. London. 1861. 

" W. D. McCaw: From address delivered at the banquet to Gen. Ster ber , June 8, 1908. 



186 History of Military Medicine 

the Indian sounded his war-whoop and the coyote ranged at will, are now covered by farms 
and pastures, by cottages and mansions, with a sturdy and prosperous people. When 
one goes West now for the first time in a palace car and sees the Stars and Stripes floating 
over many a school-house, he can form no idea of the long and perilous journey of former 
days by stage coach, by wagon train or on horseback, and the comfort that the same flag 
brought when it was sighted above the little camp or cantonment. Under the protection 
of the forts grew up humble villages and scattered ranches, dwellings built of mud, of 
sod, or rough-hewn timber. The army fought for these people when occasion oflPered 
(and there was seldom a time when there was not fighting somewhere between the Canadian 
and Mexican borders), but it made life possible for the settlers in many other ways, and 
the lonesome post surgeons did their part manfully." 

During the administration of the forceful and capable Thomas Lawson (1836-61) 
military rank was secured for medical officers in 1847, while in 1856 a great advantage 
was gained through the enlistment of hospital stewards as such. The next Surgeon 
General, William A. Hammond (1862-4), a man of open mind and big personality and 
one of the most eminent physiologists and neurologists of this country, started the Army 
Medical Museum (1862), urged the foundation of an Army Medical School (1862), fostered 
the administrative reforms of Letterman in the field, and created special military hospitals 
for the study of cardiac, pulmonary and nervous diseases, from which came the important 
work of J. M. Da Costa on irritable heart in soldiers (1862) and of Weir Mitchell, G. R. 
Morehouse and W. W. Keen on gunshot injuries of nerves (1864) . Under Surgeon General 
Joseph K. Barnes (1864-82), the exclusive control of General Hospitals was vested in the 
Medical Department. Under General John Moore (1866-90) instruction in first aid was 
inaugurated (1886) and a Hospital Corps, enlisted solely for duty in the Medical Depart- 
ment, was authorized by Congressional Act of March 1, 1887. A new field equipment 
was acquired under Gen. Charles Sutherland (1890-93). General George M. Sternberg 
(1893-1902), Surgeon General during the Spanish-American War, and the pioneer bac- 
teriologist of the country, founded the Army Medical School (1893), established bac- 
teriological laboratories at the School and the posts, established a hospital for tuberculosis 
at Fort Bayard, and created the Army Nursing Corps (1901). 

The Dodge Commission recommended imprimis a larger quota of 
commissioned medical oiBScers. As this was dependent upon (highly- 
improbable) increase in the Army itself, General O'Reilly created the 
Medical Reserve Corps (1908), an expedient probably suggested to him 
by the corps of medical cadets organized August 3, 1861 to meet the 
deficiency of medical officers in the Civil War, and in which he had 
served as a youth. The Medical Reserve Corps was made up of promi- 
nent physicians in civil life, who cooperated with the Medical Depart- 
ment in its endeavor to secure personnel of the best type. Meanwhile 
a year's supply of hospital furniture, equipment and medicines for an 
army four times the statutory strength was stored in the Medical 
Supply Depots, so that the Medical Corps was now in position to equip 
base hospitals and field units for war service more rapidly than their 
personnel could be brought together. Thus two seed plants for supplies 
and personnel — the prime desiderata of armies in wartime and the 
main recommendations of the Dodge Commission — had already been 
secured prior to our entry into the European War. 



Nineteenth Century 187 

Of tlie achievement of medical officers of the Civil War period we 
may mention the pioneer work of J. J. Woodward in photomicrography, 
of Billings in public hygiene, hospital construction, vital statistics (U. S. 
Census) and medical bibliography (Index Catalogue), of Woodhull on 
the exhibition of ipecac in dysentery (1875-6), of Weir Mitchell on 
peripheral nerve lesions. American neurology came out of the Civil 
War, and in the work of Hammond, Mitchell and J. C. Dalton, may be 
said to have grown up in the Army.^" Meanwhile the acquisition of new 
tropical possessions gave to the Medical Corps an opportunity eagerly 
grasped, and which came to prompt fruition in the shape of new dis- 
coveries in the field of tropical medicine. The great impetus given to 
bacteriological research by Sternberg led to the work of Reed, Carroll, 
Lazear and Agramonte on the transmission of yellow fever (1900) and 
the subsequent sanitation of Panama by Gorgas (1904-13) which made 
the Canal possible. During the typhoid epidemic in the Spanish- 
American War fly-transmission was demonstrated by Walter Reed, 
Victor C. Vaughan and Edward O. Shakespeare (1899). In 1899 Hoff 
vaccinated the Porto Rican population against small-pox and stamped out 
leprosy in the island. In 1909 F. F. Russell vaccinated the army against 
typhoid fever. The work of the Medical Corps in the Philippines is 
analogous to that of the Indian Medical Service in Hindustan.®^ The 
Anglo-Indian medical officers did brilliant work in the investigation of 
tropical diseases (Lind, Murchison, Vandyke Carter, Leonard Rogers), 
of serpent venoms (Russell, Fayrer), of hypnotism (Esdaile), of heat- 
stroke, and in therapeutics (Waring), surgery (Freyer), ophthalmic 
surgery (Macnamara, Smith, Elliot) and the anthropology and natural 
resources of the whole Indian peninsula. In the science of communicable 
diseases the Medical Corps of the U. S. Army has to its credit the 
pioneer work of Ashford on hookworm infection and tropical sprue, of 
Craig on malarial fever and the parasitic infections, of Craig and Ash- 
burn on filaria and dengue, of Vedder on the casuation of beri beri and 
the use of emetine in amoebic dysentery, of Chamberlain on hookworm 
infection and beri beri, and of Gentry and Ferenbaugh on Malta fever. 
On the didactic side such text books as those of Christie on X-ray diag- 
nosis (1913), La Garde on gunshot wounds (1914), Munson (1911) and 
Havard (1909) on military hygiene, Straub (1910) and Ford (1918) 
on medico-military administration and Mason on hospital corps in- 
struction (1912), are only a few indications of the spirit of professional 
and scientific preparedness which animated and informed the Medical 
Corps prior to its participation in the European War. 



«» W. Browning: Sources of Intellectual Power. Osier Anniv. Vol., N. Y., 1919, I, 881. 
•I For an account of which see, F. H. Garrison: Edinb.. M. J., ]*>14, n. s., XII, 425-432. 



CHAPTER IX 
The European War 

Henry James once defined aristocracy as "bad manners organized." 
Carlyle opined that democracy is "an institution that permits Judas 
Iscariot to slap Jesus Christ on the back." Between these two extremes 
Hes somewhere the delectable via media of the Greeks, the medium 
termer e tuiissimum of the Romans, the pathway followed by the world's 
gentlefolk in all periods of historic time. In the 19th century the 
great principle, "choose equality and flee greed," was lived up to by all 
serene people whose feeling for balance, poise, equity, proportion was 
such that they did not take themselves seriously, did not expect others 
to take them seriously, and thus maintained their own internal security 
with a noble simplicity toward their environment and their fellow 
creatures. Meanwhile, toward the end of the period, the industrial- 
democratic movement engendered by the Napoleonic wars reached its 
height. In the olden time the small producers, the artisans, trades- 
people and mechanics, were those who fed, clothed, buried us and 
generally took care of us through life. Through the invention of vast 
numbers of mechanical and labor-saving devices these now gave way 
to a great manufacturing and commercial class, which was, in turn, 
devoured by the regime of capitalists, exploiters and promoters, with an 
industrial proletariat as its vassals. The eflFect was to produce a con- 
tinuous trek of countrypeople to the cities with the usual consequences 
of new industrial diseases, bad sanitation, poverty, prostitution and high 
infantile mortality as Nature's set-off to overpopulation and over- 
crowding. Under the unnatural stress and competition of city life 
the struggle for existence obtained with full force, a phenomenon 
which received its true explanation, as biological doctrine, in the writings 
of Darwin. But what the quiet naturalist of Downs had described as 
a working principle in the pitiless scheme of Nature, inimical to the 
higher development of man (since man carries, in the very structure of 
his body, the evidences of "his lowly origin"), became, in Schopen- 
hauer's gloomy and powerful picture of human history, the "will to 
live" as the impetum faciens or driving force behind the uglier phenom- 
ena of man's existence. In the philosophy of Friedrich Nietzsche this 
became the "joyous affirmation of our being," and was exalted into an 
ethical principle in opposition to the Eastern doctrine of the renuncia- 
tion of existence and the "slave-mortality" of Christianity. Nietzsche 
was a talented professor of philology who, as a youth, ran errands for 
188 



Twentieth Century 189 

Richard Wagner and whose amatory propositions were repelled by the 
authoress, Lou Andreas-Salome. His disinclination to continue as 
press-agent for Wagner, his disgust at the mawkish parade of Christian 
symbolism in Parsifal (an artistic blunder perpetrated by the composer 
to please his second wife) led to a break in these friendly relations, which 
proved a distinct tragedy in Nietzsche's life. He ended his days as a 
madman. A master of epigram, with an otherwise abominable literary 
style, his realistic philosophy is the most ferocious assault on the ethics of 
Christianity ever made. It voices, in brief, the doctrine of the super- 
man or "blond beast" as the natural lord of existence, the inevitable 
subjection of people with botched bodies and inferior minds as "slave 
races," the necessity for a thoroughgoing "transvaluation" of all current 
ethical values, and the old Greek idea of the eternal and cyclic recur- 
rence of all worldly events (history repeats itself). Nietzsche's phil- 
osophy is thus a composite of elements variously discoverable in the 
writings of the pre-Platonic philosophers, Machiavelli, La Roche- 
foucauld, Chamfort, Stendhal, Emerson, Walt Whitman, Roosevelt 
and later moderns, and is now become a commonplace in the cheaper 
fiction of our current magazines. All that Nietzsche has to say of the 
morbid and mealier-mouthed elements in Christianity as a practical, 
working system of ethics is contained in the epigram of Heine: "Chris- 
tianity, by inculcating hound-like humility, has proved, in the end, the 
surest support of despotism;" but with this inconsistency, that Nietzsche 
regarded despotism and the enslavement of inferior peoples as an ex- 
cellent thing in itself. The Nietzsche philosophy, once a private 
luxury of antique despots and more recent artists and literary virtuosi, 
is thus in the nature of dangerous dynamite in a society based upon 
industrialism in which even rulers, soldiers, clergymen, physicians, 
artists and poets are virtually industrials. It is also inimical to the 
valid principle which emanated from the Cromwellian brow of .Jeremy 
Bentham — "the greatest good of the greatest number" — upon which 
modern medicine, sanitation and social endeavor are based. 

The small kingdom of Prussia, which after 1870 dominated modern 
Germany, was developed upon the Roman and mediaeval theory- of the 
State as an entity to which the rights of the individual must, on occasion, 
be sacrificed, and its growth in political and military power was attained, 
as with the Romans, by making war. Serfdom existed in Prussia until 
the early years of the 19th century. The dominating military caste or 
autocracy, endowed with the powerful physical habitus of a Northern 
race and with administrative abilities of a unique order (the results of 
long experience and training), constituted, in a local relation, the tribe 



190 History of Military Medicine 

of supermen of Nietzsche's dreams. These Nordics were, many of 
them, not different from other Nordics in overweening selfishness, 
arrogant demeanor, hard conceit, mordant, metalhc humors,^ and the 
blundering mentality which impels the aboriginal male to take the bit 
in his teeth and drive his head against stone walls; others, of cleverer 
type, fenced themselves behind the artificial politesse sterile et rampante 
of the 18th century; others, endowed with clear, lucid minds, had 
the simplicity, courtesy, geniality and inevitable good taste which go 
with such minds. 2 The general run of the population, described by 
Maximilian Harden as "a crude but courageous people," were not 
without some of the virtues which Lord Byron satirically ascribes to 
"the nations of the moral North," and there were French and Jewish 
refugee elements that made for practical ability and a sense of real values. 
Upon this people devolved the management of the great German 
Empire after 1870. The government was entirely in the hands of the 
privileged caste, with the Kaiser as supreme war-lord, and a highly 
organized bureaucratic machine which, not unlike that of mediaeval 
Byzantium, controlled the public affairs of the smallest and remotest 
hamlets. The success of this administrative machine in regulating 
commerce, customs duties, agriculture, finance, education and the 
sanitation of model cities was, for a long time, the admiration of the 
civilized world. The German organization of scientific investigation, 
their remarkable thoroughness in physics, chemistry, medicine and 
other branches of laboratory science, as also their skill in mechanical 
inventions and mechanisms of precision, made them the masters of 
reality; while, at the same time, the South German production of many 
charming things of human interest, from music "the best in the world" 
to children's toys and the Christmas tree, were so attractive that many 
cultivated people regarded Germany as their "intellectual home." 
Germany was regarded as the model state and, partly in consequence 
of this adulation, there grew up, following the accession of Wilhelm II, 



' The offensive and somewhat meddlesome type of banter, which would elsewhere be resented as 
a gross personal liberty, was noted by John Jay and other American travellers in the early 19th century, 
and even in the private letters of the charming alto, Hermine Spiess. Theodor Fontane, the poet of 
Berlin and of the Preussenlum, describes the typical Berlin Hausvaler as ready to snap his wife's head 
off on the slightest provocation, no matter how amiable, reasonable, affectionate or submissive her 
disposition might be. 

^ Of all ofEcers of the Prussian Army, there were none of finer mould than the late Surgeon General, 
Leut. Gen. Otto von Schjerning. He was genial, pleasant, courteous, affable, and as shown by his 
introduction to the German Medical History of the War, absolutely fair-minded and free from preju- 
dice. He was, incidentally, one of the masters of Roentgenology, in which he could have made a great 
reputation but for his tendency to efface himself, using his high position to forward the science behind 
the scenes and encouraging others to " go up and occupy" as Sidney Herbert did in the case of 
treatise on hygiene. 



Twentieth Century 191 

the ancient Jewish cult of a "chosen people," the same cult which 
Matthew Arnold ridiculed in the Anglo-Saxons of the post-Napoleonic 
period. The short, successful campaigns of 1864-6 and 1870 engen- 
dered the belief that more could be accomplished in wars of conquest. 
For nearly half a century (1870-1914) preparations of the most inten- 
sive and extensive character were made, including wholesale manu- 
facture of ordnance and munitions, training of the available male 
population for instant mobilization, an enlarged navy, the new devices 
of submarine and dirigible aircraft, an elaborated system of spies and 
foreign agents for propagandism, and the education of the people, from 
childhood up, in the hope and belief that German efficiency was pre- 
destined to dominate the world. 

All this produced a narrowing, brutalizing effect upon the minds of 
the people, who, in earlier days, had been universally liked for a certain 
broad, genial, tolerant, good-humored and hospitable humanity. It 
began to be perceived by observant travelers that the multiform Ger- 
many of the past, the Germans of the older romantic dispensation, existed 
only in spots. Continental Europeans and expatriated Americans 
who were "in the know," realized that a great world war was inevitable, 
but the warnings of shrewd observers like Lord Roberts, Lauder 
Brunton, Cheradame, Emil Reich and others were either ridiculed or 
ignored. The pre-disposing and exciting causes of the pan-European 
war, some of them rooted in the remote past, are multiplex and defy 
analysis; but overwhelming evidence exists that it was deliberately 
planned and precipitated, and that, in the words of Norman Thomas, 
"it was not a spontaneous outburst of racial antagonism, but a clash of 
imperialist interests, primarily economical, brought about by financiers, 
diplomats and soldiers who, for shortsighted ends, played upon mob 
psychology." The tragedy at Sarajevo, followed by the Servian im- 
broglio, fired the train, and the Kaiser declared war on August 1, at 7.10 
p.m. The effect was that of the thunderclap preceding a great storm 
of uncertain duration. In the lull which followed people had time to 
collect their thoughts a little. Just before the declaration of war 
Wilhelm Ostwald had denoimced the hysterical "fear of Russia" 
apparent in Germany. Americans were puzzled that the Germans, 
then at the top-notch of their commercial prosperity, should, contrary 
to Bismarck's warning, challenge fate^ and imperil their future by 



> The Franco-Prussian War was precipitated by Bismarck, but in after years he was wise and tem> 
perate in his foreign policies, realizing that the next great European War would be a "saignee d blane." 
In his later period, he declared that his governing principle was " Undafert, nee regilur" — to be guided 
by the trend of events rather than to attempt to direct them. His seal-ring bore the Russian device 
' Nicheto." i.e., take things as they come. 



192 History of Military Medicine 

"fighting for pifile." The EngUsh remained, as usual, cool and col- 
lected, and Parliament went into the war, like the Elizabethan seafarers, 
with bursts of laughter. German newspapers requested that, for 
economy of administration, the Allies send in their declarations of war 
"by the dozen" (dutzenderweise) . Meanwhile Lord Kitchener pre- 
dicted that the war would last at least three years and stated the pro- 
phetic belief that few of those who began it would live to end it. Little 
realizing what was in store for them the German regiments in brand- 
new field-gray uniforms marched down to the Rhine, singing their 
patriotic songs, to meet a vigorous and valorous counter-check in 
Belgium, and eventually to settle down to the bloody stalemate of 
the Western Front. As the immense conflict wore on it began to 
shake the remote confines of America, x\sia and Africa. The con- 
viction penetrated the minds of most reasonable people that the pre- 
cipitation of this war was a crime of lese-humanite, or, in the words 
of Sudermann, "the most gigantic imbecility since the Crusades." 
It meant the destruction of the 19th century civilization, the advent 
of a drier, more tedious, more metallic order of things in opposition to 
the broad, inclusive ways and designs of multiform universal nature. 
It was felt that the future of humanity, the hopes of centuries of patient 
endeavor, were at stake in this war; and it was upon this world-wide 
conviction that the Allied nations were eventually able to gather force 
to end it. The three wars which preceded the World War had con- 
siderable teaching value, but, except in military medicine, the lessons 
were not heeded. 

The South African War (1899-1902) was, in respect of the curious Anglo-Saxon 
indifference to preparedness, not unlike the Crimean or Spanish-American wars. In 
the early stages the British suffered considerably (especially in officer personnel) from the 
pitiless marksmanship of the Boer riflemen who were natural skirmishers; it was not 
until Kitchener had concluded his enveloping operations that the contest was brought 
to successful termination. The only field medical units, Lynch points out, were the 
litter-bearer companies (organized 1879-80), the field hospitals (one for each brigade), 
with additional reserve hospitals for divisions and corps, but no clearing houses for the 
sorting and evacuation of the wounded to the rear. This led to the invention of the 
mobile casualty clearing station or evacuation hospital (1907), situated at railhead, for 
triage, housing and ultimate evacuation by improvised hospital trains. DiflSculties with 
typhoid fever brought about the initial experiment in preventive vaccination of a com- 
mand, which, while not entirely successful, established the practice in military procedure. 
The leorganization of the Royal Army Medical Corps following the war resulted in enlarged 
authority for British medical officers, better education and training at Netley, increases 
in medical personnel and supplies, the union of litter companies and field hospitals to 
form field ambulances (1905) and the foundation of the Journal of the Corps, devoted to 
military medicine. 

The Russo-Japanese War (1904-5) found the Japanese army well organized along 
German lines, particularly their medical department, which employed Letterman's 



Twentieth Century 193 

system of evacuating the wounded, at the same time filling in the lacuna in Letterman's 
organization (which had no bridge between field hospitals and base) by means of "Eeserve 
Medical Personnel," the equivalent of evacuation hospitals. The Russian service was 
poorly organized except on paper and, like the Austrian, was behind the times in the 
matter of assigning line officers to command medical units, although an order to the 
contrary effect had been issued too late to change anything in the field. The adequacy of 
the Japanese divisional and regimental medical service was demonstrated at Mukden 
where they evacuated their wounded with precision, while the Russians suffered terrible 
losses and elsewhere depleted their firing lines by detailing himdreds of enlisted men to 
escort the wounded to the rear. In the Japanese Army the Red Cross was subordinated 
to the Medical Department; in the Russian .Army it was given an independent status, caus- 
ing vast confusion. The Japanese first employed advanced methods of sanitation and 
front-line surgery (with high mortality of medical officers) as a means of saving and 
salvage of personnel, this new principle being WTit large in their battle-orders ("The 
Russians have more men, but we can save "more men"). The Japanese estimates for 
adequate medical personnel in field operations (10 per cent of command in wartime) led 
to the establishment of this ratio both in our tables of organization and in the European 
War; and the incorporation of evacuation hospitals in our medical administration (1910) 
was derived from this war which, with the two Balkan Wars of 1912, was effective in demon- 
strating the high efficiency of the new methods of field administration in stationary or 
trench-warfare under the stress of long-range guns and high-power explosives. Even 
our popular magazines made it plain to the public that the days of old-fashioned warfare 
in the open, with charges led by a general on horseback, were over.^ 

The European War began with the German blunder of the invasion 
of Belgium, which, through the heroic resistance of the Belgians at 
Liege and Xamur, delayed the invasion of France by two weeks. The 
French blunder of a counter-invasion of Alsace-Lorraine, instead of 
squarely facing the enemy on the north, resulted in the disasters at 
Mons and Charleroi (August 21-23) and brought von Kluck's army 
within 25 miles of Paris. The battle of the Marne (September 6-10) 
saved the day for France. Then began the race for the Channel ports 
along the Yser line (September 20-October 20), in which the Germans 
captured Antwerp and Lille but were repulsed at Ypres (October 31) 
and so failed to reach Calais and Boulogne. 

On the Eastern frontier the Russian invasion on the north was checked by the Ger- 
mans at the battle of Tannenburg (August 26), but the Russian thrust through Galicia 
resulted in their capture of Lemberg (September 5), while the Serbs defeated the Austrians 
on the Jedar, drove them out of Galicia, and invaded Bosnia and Herzegovina. To save 
the situation the Germans were forced to withdraw troops from the Western Front and, 
invading Russian Poland, were defeated at Warsaw (October 20) but won out at Lodz. 
On February 12, 1915 Hindenberg overwhelmed and destroyed the Russians in the 
battle of Mazurian Lakes, but in Galicia tl Russians captured the fortress of Przemysl 
(March 22). The Russians were then overwhelmed by Mackensen and Hindenberg, 
their whole line from the Baltic to the Carpathians was thrown back with terrible losses 



'Through kind permission of Col. Chas. Lynch, M. C, these data have been derived from his 
valuable introduction to "The Medical Department of the U. S. Army in the Euroi>ean War," soon to 
be published. 



194 History of Military Medicine 

(1,200,000 killed and wounded), and Warsaw fell on August 5. Turkey had joined the 
Central Powers on October 29, 1914, and Italy went over to the Allies on May 23, 1915. 
By this time the contest on the Western Front had resolved itself into "warfare of posi- 
tion" (trench warfare), with failure of the Allies to pierce the German lines through lack 
of adequate artillery and munitions. The British were practically defenseless in the costly 
episode at Neuve Chapelle (March 10), the French oflFensive in the Champagne came to 
nothing, and, through the use of gas, the Germans all but broke through to the English 
Channel in the second battle of Ypres. Frustrated on the sea in the naval actions of 
Heligoland and the Falkland Islands the Germans began to make war by means of subma- 
rines, bombing of unfortified towns by air-raids, the use of poisonous gases and "frightful- 
ness." Although the London Punch had pronounced the Zeppelin "my best recruiter," 
Great Britain was forced to adopt compulsory military service on May 25, 1915. The sink- 
ing of the Lusitania on May 7, 1915 with loss of 1,198 lives (124 Americans) made it a 
foregone conclusion that the United States would eventually enter the war. Manufacture 
of munitions was forwarded on a grand scale, the Allies obtaining munitions and supplies 
from America, the Germans exhausting the supplies of the Scandinavian and other 
neutral countries. Serbia was overwhelmed by Mackensen in October-December, 1915. 

On February 21, 1916 the Crown Prince began his offensive against Verdun, having 
occupied the St. Mihiel salient since 1914. Douaumont was captured, but at Vaux and 
Le Mort Homme (March 8-16) Petain held his 30-mile line against the Germans, and, in 
spite of the pronounced German advance in May and June, his famous dictum, "Us ve 
passeront pas," held good. The losses on both sides were about 500,000. The Allied 
offensive on the Somme (July-November) relieved the pressure at this stage. The British 
introduced tanks and the Germans pill-boxes of masonry behind their third-line trenches, 
while dug-outs, concrete chambers, camouflage, automatic rifles, hand grenades and antique 
helmets were in use on both sides. In the summer the Russians were victorious against 
the Turks in Armenia and reinvaded Galicia, overwhelming Bukovina after their victory 
at Lutsh (June 6). Under false promises from the disloyal Petrograd r^ime the Rou- 
manians entered the war on the Allied side in July, but were overwhelmed by the Austrians, 
Germans and Bulgarians imder Mackensen, and Bucharest fell on December 6. The 
British offensive in Mesopotamia had proved a total failure, particularly in medical 
organization, and terminated with General Townshend's surrender to the Turks (April 29). 
The naval battle off Jutland (May 31, 1916) terminated in a draw, but the Germans con- 
fined themselves to submarine activities thereafter. 

The signal events of the year 1917 were the Russian revolution resulting in the 
deposition of the Czar (March 15), and the entry of the United States into the War 
(April 6). Russia, undermined by German agpncies in the central administration, from the 
Czarina down, dropped out of the war and was given over to anarchy and Bolshevism. 
The year 1917 was the darkest of the war and little could be accomplished before the 
summer. In March, following the Allied advance between Arras and Soissons, the Ger- 
mans withdrew to the Hindenberg line, 60 miles long, in consequence of which the British 
attack on Arras resulted in only slight gains. In midsummer (July-September) a new 
Allied offensive was begun in Flanders with the object of destroying the subniarine bases 
at Zeebrugge and Ostend, but this also resulted in comparative failure. Submarine 
warfare was now unrestricted and vessels "spurlos versenkt." The successful Italian 
offensive on the Isonzo front (May-September) was counterchecked by an unexpected 
Austro-Hungarian drive into Northern Italy in November, resulting in the disaster of 
Caparetto and the Italian retreat to the Piave River 15 miles from Venice, checked only 
by French and British reenforcements. The British failure in Mesopotamia was retrieved, 
however, by General Allenby's invasion of Palestine from Egypt, resulting in the capture 



Twentieth Century 195 

of Bagdad (March 11) and Jerusalem (December 9), a triumph of tactical maneuvering. 
A new British ofiFensive at Cambrai (November 22-December 31) was partly successful 
through the employment of tanks. The United States declared war on Austria on Decem- 
ber 7. In the treaty of Brest- Litovsk the Russian Bolsheviki made peace with the 
Germans, thus enabling the latter to concentrate all their forces on the Western Front. 

Early in 1918 the Germans began to prepare for a great final offensive, and the Allies 
coordinated and unified their efforts under the supreme command of General Foch (March 
28). On March 21 Ludendorff began his drive on the Somme with an army of 1,800,000, 
eventually covering a front of 100 miles, and on several occasions almost succeeded in 
breaking through the lines by ruthless sacrifice of dense formations hurled forward in 
successive waves. Although the whole Somme area was reconquered, the offensive around 
Chemin Des Dames was blocked by Foch's superior strategy, but a third drive (May 27), 
deploying 400,000 men, reached the Marne (40 miles from Paris) and extended to Ch&teau- 
Thierry. A fourth offensive in the Rheims sector (July 15) was balked, and immediately 
thereafter the general Allied offensive was launched by Foch on July 18. In this American 
troops, who had taken part in different sectors since November, 1917, distinguished them- 
selves signally in blocking the German advance at Ch4teau-Thierry (July 18), in reduction 
of the St. Alihiel salient (September 12) and in the subsequent offensive in the Meuse- 
Argonne region. The Allied advance was along the whole line from the Channel to Verdun, 
the Germans retreating through Northern France and Belgium with rear-guard action. 
The signing of the Armistice on November 11, 1918 enabled the enemy to retire without 
further damage to themselves. 

In the matter of medical administration for the war the French, 
like the Germans, mobilized all their physicians for the service of the 
country, those too old for field duty continuing at their posts as prac- 
titioners and teachers, at the same time managing, on occasions, difficult 
cases from the front at their special clinics. In this way much valu- 
able original work was incidentally done in neurology, oto-rhino-laryn- 
gology, orthopedics and the other specialties. The device was possible 
in France, Germany, and eventually England because, in these coun- 
tries, clustered as they were about the theatre of war, the distance 
between front line and base was not great. Some elderly practitioners 
even rendered valuable military service in mufti. Blanchard, the 
eminent parasitologist, orginated the idea of evacuation of the wounded 
by aeroplane. Tufiier, in some respects the most influential medical 
personality in France, managed the administration of front-line surgery 
for the entire army in civilian attire, his directions about procedure and 
technique being transmitted by telephone along the whole line, where 
necessary. England, facing the necessity of raising a corps of 12,000 
medical officers as speedily as possible, had to acquire no less than 11,000 
of these from the civilian profession, and it was her application for 3,000 
additional medical officers from America that speeded up the mobiliza- 
tion of our own Medical Reserve Corps. The Italians who entered the 
war late, w4th ample time for preparation, profited by the experience 
already gained b^* the French and English (as we did) and thus acquired 



196 History of Military Medicine 

an excellent medical organization. The medical department of the 
German Army was fully prepared as to personnel, supplies and rolling 
stock, and had even blocked out methods for the reconstruction and 
reeducation of the wounded and disabled ten years before the war. 

During the war period our own army, with an authorized strength of 230,656 (Act of 
June 3, 1916) expanded from a nucleus of 217,272 officers and men (January, 1917) to a 
force of 1,452,516 officers and men in one year's time, and, at the date of the armistice, 
comprised 3,567,856 officers and men, or nearly twelve-fold expansion; while the Medical 
Corps which, on June 30, 1916 consisted of 443 medical officers, 146 medical reserve officers 
on active duty and 4,670 enlisted men, had expanded by November 30, 1918, to an organi- 
zation of 30,591 medical officers (989 regulars, 29,602 temporary) and 264,181 enlisted 
men, a total of 294,772 on active duty. At the end of the war the Medical Corps was thus 
one and one-third times the size of the whole Regular Army of January, 1917. Two new 
organizations, a commissioned Sanitary Corps and a commissioned Ambulance Service 
were created, and, as shown in the Surgeon General's Reports, the commissioned Dental 
Corps was expanded from 86 to 4,620, the commissioned Veterinary Corps from 62 to 
2,002, the contract surgeons from 181 to 939, the Army Nurse Corps from 403 to 21,480, 
and the civilian personnel from 450 to 695. The Surgeon General's Office was expanded 
from a personnel of 7 medical officers and 148 civilian employees (April 6, 1917) to an 
organization of 32 administrative units, with a personnel of 262 medical officers and 1,617 
civilians (November, 1918). For the Medical Department Congress had appropriated 
by November 4, 1918 a sum of $471,188,948, of which $314,544,000 was spent, or only 
2.2 per cent of the total war expenditure, estimated at $14,244,061,000. This expenditure 
was wisely, liberally and carefully administered by the Division of Finance and Supplies 
of the Surgeon General's Office, which did signal service in creating new supply depots in 
our larger cities, getting in immediate touch with the leading manufacturers and mer- 
chants of the country, fostering the manufacture of drugs, instruments, bandaging material, 
and patented preparations which could no longer be obtained from Europe, and giving all 
necessary aid to the prompt shipment of these articles to the Western front. 

A remarkable feature of the World War was the exploitation of all 
branches of science, from mathematical physics to psychology, from 
anthropology to entomology, and the utilization of the aid of scientific 
men on a scale never dreamed of before. In Germany this had gone on 
for years as part of the definite scheme of preparation for war of con- 
quest, and the spectacled physicist and chemist in the dim background 
behind the General Staff became, in reality, a more formidable personage 
than the bomb-thrower or the infantryman in act to charge the trenches. 
During the war-period the chemist Emil Fischer occupied himself with 
such various problems as explosives, the invention of substitutes for 
animal fats, experimentation with synthetic foods and artificial means 
of obtaining nitrogen. In England physiologists like Starling and 
Leonard Hill rendered valuable service in the problems of war-gassing 
and asphyxiation, while Henry Head gained new insight into the physiol- 
ogy of the nervous system from the phenomena engendered by battle- 
wounds; Mott studied shell-shock and Lewis the neuro-cardiac syndrome 



Twentieth Century 197 

adumbrated by Da Costa. In France Marie and his fellow-neurologists 
enlarged the science of peripheral nerve lesions and of hitherto unstudied 
syndromes engendered by gunshot wounds of remote parts of the central 
nervous system; Carrel applied to wound-treatment the solution of a 
gas in a liquid devised by the English chemist Dakin, and the experts 
in reconstruction invented novel mechanical substitutes for the human 
hand to enable the mutilated soldier to gain a livelihood in various 
avocations. In our own army the psychologist determined the mental 
age of the enlisted man, the anthropologist measured him, the psychia- 
trist gave further aid in passing upon his mental condition, the metabolist 
and food chemist passed upon his ration, the physiologist and otologist 
determined the service requirements of the aviator, the physiologist 
and pathologist studied the effects of war-gasses, and the eye and ear 
specialists forwarded the reeducation of the war-blind and war-deaf. 
In the first year of the war the most eminent medical men of the country 
flocked to the colors and their services materially enlarged the scope of 
military medicine. Had it not been for the submarine difficulty, it 
would have been obviously simpler and more practicable to transport 
the major part of our drafted forces directly to France for training 
adapted to conditions in the war zone. But even before the arrival 
of the Chief Surgeon in France six fully equipped base hospital units 
managed to get across (May 8-25, 1917), viz., those from Cleveland, 
Boston, New York, Philadelphia. St. Louis and Chicago, which were 
distributed among the British Expeditionary Forces. In all 50 base 
hospital units were overseas by June 18, 1918. On September 4, 1917, 
through the bombing of the hospital group at Dannes Camiers by a 
German aeroplane, Lieut. William T. Fitzsimons and others were 
killed. The first American to render the supreme sacrifice was a 
medical officer. 

Shortly after the arrival of General Pershing and his stafif in Paris on June 13, 1917 
Colonel Bradley (Chief Surgeon, A. E. F.) and his assistants set about the problem of 
acquiring hospitals for the base ports and lines of communication. The American line 
of troops being on the extreme right of the western front in the vicinity of Belfort, the 
locus of hospital sites was a line passing through the four base ports (Bordeaux, La Rochelle, 
St. Nazaire, Brest), the training areas (Gondrecourt, Neufchateau, Mirecourt, Valdahon) 
and along the two lines of communication, viz.: (1) St. Nazaire, Nantes, Angers, Tours, 
Romorantin, Gievres, Nevers; and (2) Bordeaux, Perigueux, Limoges, Chateauroux. As 
our troops poured into France and casualties began to come in from the battle-lines, the 
original estimates for hospital beds was advanced from 73,000 beds to 600,000. On May 
1.3, 1918, thirteen days before our First Division got into action (capture of Cantigny), 
there were already 30,187 beds available. On Armistice Day there were 261,403 beds 
available in France, with 193,448 patients in hospital (99,405 sick, 99,043 wounded), 
and in the home territory, 121,883 beds, with 69,926 patients, or a total of 353,887 beds 
in France and the United States, over twice the number available for the Union forces 



198 History of Military Medicine 

in the Civil War (118,057 beds). The larger hospital centers in France (Allerey, Bazoilles, 
Toul, Mesves, Mars, Savenay) were originally 1,000 bed units with a crisis expansion, 
but some of these became in time great communities of as many as 30 base hospitals with 
an emergency bed capacity of 10,000-40,000 beds. The Mesves Hospital Center had 
'rn November-December, 1918 25,000 beds, with 20,186 patients (November 11), the total 
personnel and patients (28,828) outnumbering a division of infantry. Evacuation of 
the wounded from front to base, and eventually to the home territory, proved a large 
contract for the Service of Supplies, on account of the initial difficulties in obtaining 
hospital trains and other rolling stock, the frequently impassable conditions on the roads 
leading to the battle front, the stalling of vehicles and other disagreements common to 
war-zone operations. By November 11, 1918 129,997 patients (50,580 sick, 79,517 
wounded) had been evacuated in 21 hospital trains of 16 coaches each, while 197,708 
primary evacuations had been made in 50 trains lent by the French. Some 6,875 ambu- 
lances were sent to France and Italy and about 50 barges were in use on Fren<^h water- 
ways. By November 11, 1918 86,642 patients had been evacuated by ship from the base 
hospital ports to the United States. 

The Chief Surgeon's office at Tours was organized in five administrative divisions, 
controlling the services of hospitalization, evacuation and hospital administration, sani- 
tation, sanitary inspection and medical statistics, personnel, medical supplies, finance 
and accounting. The Service of Sanitation of the A. E. F. covered the organization of 
stationary and mobile laboratories, controlled by a Central Laboratory at Dijon, the 
sanitation and sanitary inspection of training and hospital areas, camps, base and their 
local hospitals, combat areas (trench hygiene) and moving armies, the preparation of the 
sick and wounded reports, and the analysis and study of communicable diseases in the 
Office of Epidemiology. The Central Laboratory provided for the prevention of threat- 
ened epidemics, allotment of standard supplies, training and research work. By coopera- 
tion with the Chief Engineer's Office a supply of pure water was insured, while routine 
examination of water supplies was managed by the Central Laboratory. Through the 
experts sent over by the Food Division, S. G. O., a modified ration was established by 
G. O. 176, G. H. Q. (October 11, 1918). At the Army Sanitation School at Langres 
lectures and training were given by experts in all branches of military medicine. These 
were of eminently practical tendency, based upon actual experience in the war-zone, and 
included the training of dental officers in field duty, extended in this case to administra- 
tion of ansesthetics, first aid and general minor surgery. 

In the Surgeon General's Office at Washington the Personnel Division built up the 
expanded Medical Reserve Corps and other branches of the medical service; the Division 
of Sanitation looked after the sanitary inspection of all army stations in the country, par- 
ticularly the 32 training camps (some of the communities of 40,000-50,000 people), and, 
at the same time, managed the inspection of food, the prevention of communicable diseases, 
epidemiology, the developmental battalions and the preparation of medical records and 
statistics; the Hospital Division supervised the construction and management of camp, 
general and other hospitals; the Laboratory service was in charge of a special division, 
which also controlled communicable and venereal diseases; the Divisions of Medicine 
and of Surgery selected professional personnel and equipment for the hospitals and other 
stations; while neurology, psychiatry, psychology, dentistry, veterinary medicine, anthro- 
pology, gas defense, aviation service and phj^sical reconstruction were each of them sep- 
arately administered. The Medical Training Camps at Fort Oglethorpe and elsewhere 
gave intensive military, professional and special training to Medical Reserve Officers, while 
those admitted by examination to the Regular Corps received training at the Army 
Medical School. .At the Medical Training Camps certain defects in American medical 



Twentieth Century 



199 



education at various schools revealed themselves. In prosecuting the medical history of 
the War every encouragement was given to medical officers to publish the results of the 
findings in hospital or laboratory where time and opportunity afforded, and a number 
of magazines and practical handbooks were printed. In 1916 The Militart; Surgeon 
was improved in format and typography and became the principal repository for articles of 
this kind. Much valuable assistance was rendered to the Medical Department by the 
American Medical Association, the Council of National Defence, the National Research 
Council, the American Red Cross, the Rockefeller Institute, the Carnegie Institution of 
Washington, the U. S. Public Health Service, and other governmental departments and 
extra-military organizations. During the war period the medical administration of the 
British army was conducted by Gen. Sir Alfred Keogh and his successor Gen. Sir John 
Goodwin, that of the French by MM. Justin Godart, Simonin and Tuffier, that of the 
American by Gen. William C. Gorgas, that of the German by Lieut. Gen. Otto von 
Schjerning. The Chief Surgeons of the American Expeditionary Forces were Col. 
(Brig. Gen. N. A.) A. E. Bradley, Gen. Merritte W. Ireland, and (after October 4, 1918) 
Gen. Walter D. McCaw. 

Statistic and Battle Losses 

It is roughly estimated that nearly 60,000,000 men were mobilized 
by the 16 nations engaged in the World War, and that of these about 
one-third died or were killed, of whom over 7,000,000 were soldiers and 
sailors. The number of civilians who died from direct or indirect causes 
was tremendous. The following table gives an empirical estimate of 
the military losses compiled from various sources:^ 



Nation 



Mobilized 



Killed and 

died from 

wounds or 

disease 



Wounded 



Missing or 
prisoners 



Total 



British Empire. . . 

France 

Russia 

United States 

Italy 

Belgium 

Roumania 

Serbia 

Montenegro 

Greece 

Portugal 

Japan 

Germany 

Austro-Hungary . 

Bulgaria 

Turkey 

Total: 

Allied Powers . . 
Central Powers 

Grand Total 



8,654,467 

8,407,000 

12,000,000 

4,175,367 

5,500,000 

267,000 

750,000 

707,343 

50.000 

230,000 

100.000 

850.000 

11.000,000 

6,500.000 

400,000 

1,600,000 



929,812 

1,109,000 

1,700,000 

112,855 

460,000 

104,779 

200,000 

322,000 

3.000 

15,000 

4.000 

300 

1.686.061 

800.000 

101.224 

300.000 



41,640,177 
19.500,000 



4.960.746 
2,887,285 



2.097.994 

3.025.613 

4.950.000 

224,089 

947,000 

77,422 

120,000 

28,000 

10,000 

40,000 

15,000 

907 

4,211,469 

3,200,000 

152,399 

570,000 



11,535,718 
8,133,868 



32,391 

252,900 

2,500,000 

14,363 

1,393,000 

10,000 

80,000 

100,000 

7,000 

45,000 

200 

3 

991,341 

1,211,000 

10,825 

130,000 



4,434,857 
2,343,166 



3,063,664 

4,387,513 

9,150,000 

351,207 

2,800,000 

192,201 

400,000 

450,000 

20,000 

100,000 

19, 200 

1,210 

6,888,871 

5,211,000 

264,448 

1.000,000 



20,934,995 
13,364,319 



7,848,031 



19.669,586 



34,299,314 



' General Goodwin's estimate of British losses, furnished to the Surgeon General on January 12, 
1921, was 474,254 killed in action, 139,664 died from wounds, 69,912 died from other causes, 1,668,573 
wounded, 143 missing; total: 2,352,546. The French data, as above given, were furnished to the 
Surgeon General by Brig. Gen. L. CoUardet. Military Attache of the French embassy on April 22, 
1921. Th<? Belgian data were furnished by Regimental Surgeon Voncken, editor of the Archives 
Medicates Beiges, about the same time. 



200 History of Military Medicine 

In the British Army, exclusive of Indian and African troops, the total losses were 
569,143 killed in action, 170,509 died of wounds, out of 1,025,800 wounded, 83,975 died 
from other causes, and 143 missing. The Germans had 1.531,048 killed in battle and 155- 
013 died of disease out of 19,461,205 admitted to hospital (total mortality: 1,680,061). 
Their total mortality from wounds has not yet been computed. Their total losses were 
nearly 7,000,000; those of Russia even larger. Of our own wartime army, estimated at 
between 3,567,856 and 4,123,345 oflBcers and men, 2,039,329 reported in France, and of 
these about 28 divisions (784,000 men) got into action. The total mortality on the West- 
ern front was 75,658, viz., 34,249 killed in action, 13,691 died of wounds, 23,937 died of 
disease, and 3,681 from homicide, suicide, drowning and other accidents. The total 
mortality of the U. S. Army from April 6, 1917 to December, 1919 was 112,855, including 
54,105 from battle casualties and accidents and 58,075 from disease. Thus the mortality 
from battle casualties on the Western front up to the Armistice was over twice that from 
disease, while in 1917-19, the disease mortality was 10,076 higher than that from wounds, 
due to the devastating effects of the Spanish influenza epidemic in the training camps of 
the home territory. The casualties among our medical officers in France number 442, 
including 46 killed in action, 212 wounded, 22 died of wounds, 101 died of disease, 9 died 
from accidents, 4 lost at sea and 7 missing in action, showing that over one-half (258) were 
killed or injured from exposure to enemy fire and nearly one-fourth died from exposure 
to infection in hospital or otherwise. General Goodwin estimates the battle casualties 
among regular and territorial medical officers of the British Army as 23,504, viz., 3,181 
killed in action, 1,429 died from wounds, 1,887 died from disease and other causes and 
17,007 wounded, an impressive showing. The effect of the vast improvement in wound- 
treatment by modern methods is indicated by the fact that in the Civil War 31,978 died 
from wounds in hospital (10.48 per 1,000), in the World War 13,691 (4.5 per 1,000). 
The highest incidence of war-wounds in hospital occurred during the Argonne-Meuse 
campaign, viz., 38.37 per cent of admissions to hospital, with 41.52 per cent of deaths 
from such wounds. Comparative estimates in the Surgeon General's Reports and the 
statistical data in the Medical History of the War indicate that nearly twice as many 
were killed outright by shell-wounds as were admitted to hospital for such wounds, while 
the ratio of wound-incidence to deaths in the case of shrapnel was 15.08 per cent : 14.50 
per cent. On the other hand the wounded from aeroplane accidents, aerial bombing, 
shell and shrapnel wounds had a higher case-mortality in hospital than rifle or pistol 
wounds, while recovery was the rule in the case of gassing. The experience of the Western 
front is to the effect that gassing is not nearly as destructive as gunshot injuries. While 
wounds of the chest and the extremities were most frequent, there were fewer chest and 
arm wounds than in the Civil War, and more of the head and lower extremities. More 
than twice as many men were killed from head wounds as were admitted to hospital, and 
nearly seven times as many from wounds of the abdomen, spine and pelvis. The number 
of killed and of wounded from injuries of the lower extremities was about equal. 

Military Surgery in the World War 

Dr. W. W. Keen has drawn a vivid contrast between the surgery of the Civil War and 
that of the World War.^ In the Civil War chloroform and ether were employed, but the 
hypodermic syringe, clinical thermometer, retractors and haemostatic forceps, sterilized 
gauze, rubber gloves, motor ambulances and mobile laboratories, first-aid packets, trained 
nurses. X-rays, antisepsis, iodine solutions, and preventive vaccination were unknown; 
and field surgery was eked out by the use of germ-laden sponges, buJlet-probes and silk- 
ligatures, wounds being explored or widened by surgically unclean fingers, wound-infec- 



8 W. W. Keen: New York Med. Journal, 191.5, ci, 817-824. 



Twentieth Century 201 

tion, septicaemia, pyaemia, erysipelas, hospital gangrene and tetanus were common, and 
suppuration the rule. Even S. D. Gross sometimes sharpened his knife on his boot and 
threaded suture-needles by wetting the silk with saliva. In the World War the leaden 
Minie ball, with its tendency to lodgment and deformation, was replaced by the jacketed 
bullet of high velocity, effectiverange and penetrating power at long range, but pulverizing 
hard bone at close range, as was common in the shortly separated trenches of fVance and 
Belgium. Even more frequent and more destructive were the effects of explosive shells, 
shrapnel, hand-grenades and bombs which had been familiar to military observers in the 
Russo-Japanese War; while aeroplane bombing, dropping of high-power explosives from 
Zeppelins, gassing, and the use of Flammenwerfer, "whiz-bangs" and other ancient or 
modern devices added to the general havoc and increased the surgeon's responsibilities. 
The first fact borne in upon the surgeons of the Western front was La Garde's principle 
that there is no such thing as a sterile gunshot wound. The soil of France and Belgium, 
cultivated, manured and defiled by the excreta of animals for centuries, was found to be so 
laden with B. welchii and other pathogenic germs that Dr. Sidney Rowland was able to 
inoculate a guinea-pig with gas-gangrene from a few drops of its muddy water, the animal 
dying in eighteen hours. Long periods of duty in the muddy and sometimes filthy 
trenches, furthermore, made the soldier's skin, as well as his uniform, dirty and germ- 
laden, so that bits of the latter driven into the wound almost inevitably produced infec- 
tion. Again, the rotary motion of the modern jacketed bullet, which leaves the rifled 
muzzle of the weapon making 2,500 revolutions on its long axis, reduces the soft tissues 
penetrated by it to a devitalized pulp which undergoes necrosis and is otherwise an 
ideal medium for growth of pathogenic bacteria. Surgical asepsis, under such conditions, 
was impossible; it became necessary to go back to the fundamental Listerism or antisepsis. 
It was soon found, however, that strong antiseptics, applied to deep infected wounds, 
would not sterilize them. There followed a long series of "trial and error" experiments 
with such milder preparations as the synthetic dyes of the triphenylmethane series (crystal 
violet, malachite green, brilliant green), trypaflavine (acridine series), the mixture of 
bismuth subnitrate, iodoform and paraffin known as "bip" (Rutherford Brown), or the 
hypertonic salt solutions recommended by Sir Almroth Wright to facilitate wound repair 
by increasing the flow of lymph from the wound-surfaces. Through the necessity of 
applying these mild antiseptics continuously to the surface of such Mounds, practice 
settled down to the use of the neutral sodium hypochlorite solution devised by the English 
chemist, H. D. Dakin, which was devoid of the irritating free alkali in the commercial 
hyperchlorites commonly employed in the sterilization of water. Continuous irrigation 
of the wound was secured by Carrel's device of inserting a series of rubber supply tubes, 
arranged like an inverted Jewish candlestick and fed by a common tube from the receiver. 
This liquid, along with Lorrain Smith's neutral mixture of calcium hyperchlorite and boric 
acid (eusol), depended for its action upon the disinfecting property of the free chlorine 
held in solution, which was also true of dichloramine-T, subsequently introduced as a 
spray for wound-infection, throat-infection or sterilization of meningococcus carriers by 
Dakin. The principle was copied by the Germans who, at the same time, introduced 
such preparations as vuzin or eucupine, depending for their action upon the release of 
free formaldehyde as in the case of formamint and other preparations devised by them 
for the treatment of infections of the throat, conjunctiva, genital tract, etc. In spite 
of the success of these devices in the stationary hospitals, continuous application of the 
Carrel-Dakin solution was practically impossible during the long transit of the patient 
from evacuation hospital to base, which sometimes occupied twelve hours or more. The 
forgotten principle of debridement, or excision of the devitalized, necrosed portions of the 
wound with primary suture, was revived by Lemaitre and H. M. W. Gray, and in this 



202 History of Military Medicine 

way the danger of infection between front and base was effectually bridged over, and 
thousands of lives were saved. WTien our forces arrived in France, wound-excision was 
still in the trial stage, but it soon became firmly established as a true aseptic principle 
in front-line surgery. The comparative percentages of case-mortality of wounds in the 
Civil War and the World War, as given in the Surgeon General's Reports, show the great 
advances made in wound treatment on the Western front. The case-mortality in wounds 
of the head and the extremities in the World War was reduced by nearly one-half, with 
material reduction in wounds of the chest, neck and genitals; while wounds of the back 
and abdomen showed a higher case-mortality in the World War due to the destructive 
character of the newer artillery projectiles and explosive shells. Wounds of the abdominal 
and pelvic viscera were relatively hopeless in both wars for this reason, but the case 
mortality in gimshot fractures of the long bones and joints was reduced in astonishing 
measure. The successful transportation of such fractures over long distances was greatly 
facilitated by the revival of the Thomas splint and the subsequent use of the Balkan 
frame. New light was thrown upon the pathology, prevention and treatment of trau- 
matic shock through the investigations of Porter, Crile and Cannon. Roentgenography 
was freely employed in the location of bullets, and through many new inventions and the 
splendid equipment of the American teams great advances on the technical side were 
made. Anaesthesia under the new conditions was carefully studied and became a fine 
art in the great war. Brilliant work was done in abdominal, reconstructive (orthopedic), 
maxillo-facial and neurological surgery; and the surgery of the chest was forwarded by 
experimental laboratory investigation. In this history the names of Tuffier, Morestin, 
Lemattre, Willems, Depage, Moynihan, Makins, Gillies, Jones, Cushing, Crile, Blake, 
Bastianelli and Vanghetti will be memorable. In surgical administration the English 
Casualty Clearing Station or railhead hospital, introduced into our Tables of Organiza- 
tion as the Evacuation Hospital, had existed only on paper prior to the World War. It 
proved to be most effective as a clearing-house for reception and classification of the 
wounded with reference to stationary treatment or immediate transportation to base. As 
the war approached its end and the Allies were able to make advances in the open, the 
evacuation hospitals were pushed closer up to the front-lines, and eventually centres of 
triage for sorting out the wounded were improvised. This device was further helped 
out by another invention of the Western front, the barrage or curtain of fire, behind which 
the litter-bearers were able to collect the wounded by daylight instead of after dark, with 
wonderful improvements in the mechanism and speeding up of prearranged evacuation 
during offensive movements forward. 

Military Sanitation in the World War 
The success of the Japanese in applying the modern devices of 
sanitation to the salvage of personnel in the Russo-Japanese War made 
it self-evident that, in a contest involving armies of millions, neglect of 
these principles would spell disaster worse than defeat for the unwary. 
As a matter of fact the episode of the Western front turned out to be 
the greatest triumph ever achieved by military sanitation, as shown by 
comparision with the ravages of typhus fever on the Eastern front, or 
the effects of the Spanish influenza epidemic of 1918-19, which was 
relatively more destructive to life than the war itseK. With the influ- 
enza epidemic the medical profession was dealing with a phenomenon of 
almost unknown causation, as had been the Japanese military experience 



Twentieth Century 203 

with beri beri in 1904-5. The medical officers on the western front 
found themselves confronted first of all with the problems of trench 
warfare and the diseases consequent upon prolonged exposure to cold, 
dampness, contaminated soil, filth, lack of bathing facilities and the 
ever-present possibility of vermin infestation. The Germans, fighting 
behind a cordon of heavy artillery, in which the Allies were at first 
deficient, were able to entrench themselves securely behind their third 
lines in subterranean passage-ways and chambers of solid masonry 
which could easily be kept clean; but every soldier who fought in the 
front-line trenches was predestined to become dirty and also lousy. 
Delousing, therefore, came to be an elaborated procedure, a little science 
in itself, with special stations for bathing and steam disinfection, and 
by this means typhus, and eventually trench fever, were abolished from 
the war-zone in the West, The location of the louse as the vector of 
trench-fever by English investigators and the conclusive demonstration 
of this fact by the American Commission was one of the original con- 
tributions of the war period. In like manner smallpox, the typhoidal 
infections, traumatic tetanus, diphtheria and even the dysenteries 
were rendered comparatively innocuous through preventive vaccina- 
tion. The meningitis rate was lowered by vaccination and control of 
carriers; malarial fever and tuberculosis were kept in hand; and even 
the rheumatic and gouty disorders were controlled far better than 
formerly. In the Southern camps in the United States yellow fever, 
which might have been a formidable scourge, was non-existent; but in 
the early stages of the training of drafted men the infantile diseases, 
measles, mumps, meningitis, scarlatina, exacted a heavy toll among raw 
recruits. This was partly owing to the fact that such recruits were 
often country-bred, from sparsely settled districts, and therefore non- 
immune to diseases to which the city men had been exposed from 
infancy, but also because most of these diseases are sputum-borne and 
can thus be transmitted by the hand. The sputum-borne infections, par- 
ticularly the pneumonias, remained the insoluble problem of the war. 
This was less apparent before the onset of Spanish influenza with its 
high mortality and its facile transmission by hand and mouth infection 
in the overcrowded cities; but even before this period it had become 
necessary to limit the transmission of sputum-borne diseases by segregat- 
ing contacts and suspects, by swabbing the throats of carriers, by 
making provisions for increased air-space in barracks (the statutory 
number of occupants being stencilled on the doors), by employing 
Grancher's device of making each bed-space in the wards a virtual cubicle, 
by supervising the cleaning of mess-kits, and by teaching the actual or 
suspected carrier that his mouth and hands are a menace to society. 



204 History of Military Medicine 

The highest incidence-rates of communicable diseases in our forces were those from 
influenza (729,381 or 228.14 per 1,000), gonorrhoea (220,348 or 68.92 per 1,000), bronchitis 
(208,592, or 65.24 per 1,000), mumps (195,490 or 21.13 per 1,000), syphilis (54,514 or 
17.05 per 1,000), gout and rheumatism (49,505 or 15.48 per 1,000) and tuberculosis 
(31,106 or 9.73 per 1,000); the highest mortality rates were those from influenza (7.2 per 
100) and pneumonia (5.23), the latter being due to the extraordinary malignancy of the 
pneumonias complicating measles and influenza. The epidemic of Spanish influenza 
caused 17.33 per cent of total admissions and 8.2 per cent of deaths in the Army. The 
total number of cases of sickness reported to hospital during 1917-18 was 2,422,362; 
the total number of deaths from disease 50,174 (16.67 per 1,000); with the Civil War 
rates we should have had 9,759,847 admissions and 227,094 deaths; with the Spanish- 
American War rate, 6,385,683 admissions and 112,656 deaths. In both wars there 
were 200 times as many admissions for typhoidal infections as in the World War and 100 
times as many admissions for malarial fever. These and other data, furnished in the 
Surgeon General's Reports, show the extraordinary advances made by preventive medicine 
in the 20th century. 

Control of J'enereal Diseases 

When our forces arrived in France it was soon perceived by those in 
command that a high rate of venereal infection would prove a serious 
handicap to the matter of getting troops into action, not only on account 
of the effect of such diseases upon the body, mind and morale of the 
soldier, but also because the number of days lost from duty and the need 
for segregation from comrades was as great as in the other communicable 
diseases of grave type. In 1917-18 the Allies' prospects were dark, 
the forces at the front were well-nigh exhausted from constant fighting, 
and there was a crying need for fresh personnel. At the base ports of 
debarkation, therefore, every effort was made to keep the men away 
from prostitutes and vice versa, and although it took some time to 
convince the port authorities that these efforts were not so much of a 
religious or ethical order as based upon a definite practical aim, to 
help them win victories, some modus vivendi was at length effected, 
and a sanitary cordon was established about the ports. ^Yhen the 
troops went up to the training areas the problem became more complex, 
and this was also true of the training camps in the United States. 

In the section for Combating Venereal Diseases of the Laboratory Division, S.G.O., 
an elaborate program was blocked out and carried into action, comprising (1) the use of 
prophylactic measures where necessary; (2) cooperation with the Public Health Service 
in the control of extra-cantonment areas; (3) education of the soldier in regard to the 
meaning and purpose of his sexual nature, the consequences of venereal infection and its 
effect upon his descendants and the fact that continence is nowise injurious to healtli 
but possible to every well-balanced individual; (4) appeal to his better nature by means 
of pamphlets, lectures, personal talks, moving-picture scenarios, etc. In spite of these 
efforts the incidence-rate of gonorrhoea during 1917-18, as seen from the above figures, 
came second, and that of s\-philis seventh in order of magnitude among the communicable 
diseases affecting our troops. Of 259,621 cases of venereal diseases reported in 1917-18, 
in an army of 3,361,848, about 196,000, or nearly two-thirds, were brought into the army 



Twentieth Cexturv 205 

from civil life, the remaining 62,612 being cases contracted after enlistment or which had 
escaped detection before enlistment. The venereal admission rate among negro troops 
was seven times that of the white, and among Southern troops, who showed a higher 
venereal rate than in troops from other parts of the country, the negro rate was four times 
that of the white. Ashburn's analysis of venereal statistics in the Army during 1918' 
shows 133,203 cases introduced from civil life out of 196,008. The incidence-rate of 
cases contracted after enlistment (62,805) was 45.46 per 1,000, and of these 5,024 were 
negro, 57,781 white. There were, therefore, 65,242 venereal cases brought in from civil 
lii'e by 2,023,945 whites (3.22 per cent) and 67,961 cases brought in by 325,548 negroes 
(20.87 per cent) at the ports of embarkation. Such infected troops were segregated and 
not permitted to go overseas, yet the infection rates at home and abroad were about 
equal. During the five years 1912-16, however, the rates of venereal infection in troops 
stationed in the United States were 93 per 1,000 for whites and 105 for negroes. The 
rate of venereal infection of drafted men in 1918 (56.69 per 1,000) thus lowers the earlier 
rate by one-half. The high venereal rate among men from the civil population is to be 
attributed in part to the increase in se.xual promiscuity and laxity of morals in our over- 
crowded cities under war-time conditions, and to the fact that immunity from venereal 
infection, even after e.xhibition of the newer parasiticidal remedies, is illusory. Among all 
strong peoples of the past potentia generandi was exalted above potenlia coeundi, as 
shown by the deification of the generative powers in nature even by savage races. The 
swaggering bravos in the Elizabethan plays did not boast of their amours but of the 
number of lusty children they were capable of begetting. The Greek gods in Hesiod and 
Homer were of the same mind. The artificial sterilization of marriage by chemical and 
other contraceptive measures has, as Bernard Shaw affirms, effected a complete revolution 
of opinion, as shown by the literature, art and some of the social customs of the present 
hour. It is no exaggeration to state that our period is saturated with sexuality. The 
"furtive, retiring sensuality" which Lecky attributes to the northern races has given 
place to a spirit as cynical and forward as that of the Latins in whom no Freudian com- 
plexes exist. The American is perhaps saved, in some measure, by his irrepressible 
sense of the comic. The appeal to the enlisted man is simple: You are a responsible 
member of society. If you become infected with venereal disease, you may ruin not only 
your own health, but that of your descendants. The time is approaching when society 
will deal with your case publicly, as it does with diphtheria or small-pox or leprosy. It is 
up to you. 

The World War left continental Europe in a desperately demoralized 
and distracted condition, with the necessity of creating a new social order 
or of wallowing indefinitely in the slough of despond. The peace did not 
make peace, as shown by the map and the unsettled state of Eastern 
Europe, and the European War itself indicates that war waves, which 
formerly moved from north to south, now tend to move from east to 
west. Internationalism, the socialization of the world, with armies 
and navies doing police duty for the common good, is the dream of all 
advanced and enlightened spirits, but implies a world-wide social order, 
more open-minded and tolerant, better tempered, better disciplined, 
better educated by experience, than any existent at the present time 
when the '"Red" Army of communal Russia is the largest in Europe. 



'P M. Ashburn; Miutabt Surgeon, Washington. March, 1920, xlvi, p. 328. 



206 History of Military Medicine 

As our country swings back to normal, let us hope that our people will 
begin to realize that wars are biological phenomena, that armies such 
as ours exist to stabilize society and to maintain peace, that "to steal 
away a nation's sword is to be the surest enemy of peace" (Novalis). 
The principal lesson we have learned from the European War is unques- 
tionably that to attempt to prepare for a war of magnitude in unit time 
is a wasteful and extravagant procedure the cost of which is ultimately 
borne by the people, and that without reasonable preparedness we may 
be again caught napping, and like other Anglo-Saxon countries "go 
through the sad probation all again." Our Army has been likened to 
the fire department of a large city: in periods of quietude its very exist- 
ence (little as this fact is realized) helps to stabilize the social order 
into a sense of security; in time of emergency it is there to put out the 
fire. Preparedness means preparedness to maintain peace as well as to 
make war. Wars of the future are likely to be of even more destructive 
character than the World War; the possibilities of using chemical, 
electrical and pathogenic agents are already vaunted; and in such wars 
the services of the Medical Department will be of even greater use and 
value. In the words of Taylor:^ 

"The world was far from even apprehending what it has yet to learn thoroughly, that 
in the field the distribution of medical supplies, prompt evacuation, skillful first aid, 
shelter, food, and restoratives available early for every fallen combatant are of infinitely 
more importance than highly technical relief to difficult cases. More critical still are the 
problems relating to later demobilization, to hospitalization and rehabilitation of war 
victims, and the faithful but well-ordered and economical relief of the wreckage of war. 
Millions will be spent and more millions wasted until the time comes when it is a recog- 
nized part of the program of national defense to organize methods of post bellum relief 
at the same time that activities are initiated for the prosecution of hostilities. We have 
progressed from the day of medical attendance for leaders to medical attendance for all 
combatants, and leaders are increasingly alive to the immediate necessary needs of their 
forces; but we have not yet attained to a comprehensive grasp of the requirements or 
possibilities of military medicine." 



* J. S. Taylor: United Sutes Naval Medical Bulletin, Washington, 1921. xv. No. 139